Provider Demographics
NPI:1043775372
Name:MACLELLAND, SUZANNE C (PSYD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:C
Last Name:MACLELLAND
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1752
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-1752
Mailing Address - Country:US
Mailing Address - Phone:805-203-6421
Mailing Address - Fax:
Practice Address - Street 1:7305 MORRO RD STE 201
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4445
Practice Address - Country:US
Practice Address - Phone:805-203-6421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33560103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling