Provider Demographics
NPI:1083686802
Name:MCCLUNG, TANDY J (EDD)
Entity Type:Individual
Prefix:DR
First Name:TANDY
Middle Name:J
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-6911
Mailing Address - Country:US
Mailing Address - Phone:304-376-3426
Mailing Address - Fax:304-599-2124
Practice Address - Street 1:1062 MAPLE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-0809
Practice Address - Country:US
Practice Address - Phone:304-599-5751
Practice Address - Fax:304-599-2124
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7268103TC0700X
WV488103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical