Provider Demographics
NPI:1114200987
Name:MCCLENAHAN, CONNOR BRIAN
Entity Type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:BRIAN
Last Name:MCCLENAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 VALLEY MALL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2620
Mailing Address - Country:US
Mailing Address - Phone:626-442-0710
Mailing Address - Fax:
Practice Address - Street 1:520 S GRAND AVE STE 671
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90071-2655
Practice Address - Country:US
Practice Address - Phone:323-693-7097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30369103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty