Provider Demographics
NPI:1134107014
Name:MCLEES, ELVERA ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELVERA
Middle Name:ELLEN
Last Name:MCLEES
Suffix:
Gender:F
Credentials:PHD
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 982
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-0982
Mailing Address - Country:US
Mailing Address - Phone:276-619-5888
Mailing Address - Fax:
Practice Address - Street 1:390 COMMERCE DR
Practice Address - Street 2:SUITE C
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-3876
Practice Address - Country:US
Practice Address - Phone:276-619-5888
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000337103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7705719Medicaid
VAS88909Medicare UPIN