Provider Demographics
NPI:1083099170
Name:MCLEAN, LOIS G (M,D,)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:G
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:M,D,
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 130
Mailing Address - Street 2:
Mailing Address - City:TONTO BASIN
Mailing Address - State:AZ
Mailing Address - Zip Code:85553-0130
Mailing Address - Country:US
Mailing Address - Phone:623-297-4674
Mailing Address - Fax:
Practice Address - Street 1:77 OLD HIGHWAY 188
Practice Address - Street 2:UNIT 130
Practice Address - City:TONTO BASIN
Practice Address - State:AZ
Practice Address - Zip Code:85553-9996
Practice Address - Country:US
Practice Address - Phone:623-297-4674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ82942084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry