Provider Demographics
NPI:1093292666
Name:MCLELLAN PSYCHOTHERAPY PLC
Entity Type:Organization
Organization Name:MCLELLAN PSYCHOTHERAPY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-779-7346
Mailing Address - Street 1:105 CREAMERY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:DANBY
Mailing Address - State:VT
Mailing Address - Zip Code:05739-9782
Mailing Address - Country:US
Mailing Address - Phone:802-779-7346
Mailing Address - Fax:
Practice Address - Street 1:128 MERCHANTS ROW
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-5911
Practice Address - Country:US
Practice Address - Phone:802-779-7346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty