Mclellan, Mary Jane

Mclellan, Mary Jane is an individual health care provider with primary practice located at 2415 W Kiltie Ln , Flagstaff AZ 86001-9107. She recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as her primary health care specialty. Mclellan, Mary Jane can be contacted via phone (928) 774-3086.

Contact Information

Primary practice address
2415 W Kiltie Ln Flagstaff AZ 86001-9107
Phone: (928) 774-3086
Fax: (928) 213-8507
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 3087 Arizona
Behavioral Health & Social Service Providers / Psychologist 103T00000X 1077 Virginia

Profile Details

NPI number 1407853625
LBN Legal business name Mclellan, Mary Jane
Credentials PH.D
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 1st, 2005
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407853625 NPPES
Arizona MEDICAID 361650

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