Provider Demographics
NPI:1073965018
Name:MCCLELLAN, THERESA (MS ED, TSHH)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:MS ED, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 S MAIN ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-1644
Mailing Address - Country:US
Mailing Address - Phone:585-589-5384
Mailing Address - Fax:
Practice Address - Street 1:243 S MAIN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1644
Practice Address - Country:US
Practice Address - Phone:585-589-5384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist