Provider Demographics
NPI:1174655906
Name:MCCLUNG, SCOTT ALAN (MFT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALAN
Last Name:MCCLUNG
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N RAMONA BLV
Mailing Address - Street 2:#2 MT SAN JACINTO MENTAL HEALTH
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582
Mailing Address - Country:US
Mailing Address - Phone:951-487-2674
Mailing Address - Fax:951-487-2679
Practice Address - Street 1:950 N RAMONA BLV
Practice Address - Street 2:#2
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582
Practice Address - Country:US
Practice Address - Phone:951-487-2674
Practice Address - Fax:951-487-2679
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34485106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist