Provider Demographics
NPI:1184844854
Name:LECLEAR, DENNIS A (MA, MED)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:A
Last Name:LECLEAR
Suffix:
Gender:M
Credentials:MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10144 CASTLE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053-8642
Mailing Address - Country:US
Mailing Address - Phone:269-370-2899
Mailing Address - Fax:269-344-8642
Practice Address - Street 1:10144 CASTLE CREEK CIR
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:MI
Practice Address - Zip Code:49053-8642
Practice Address - Country:US
Practice Address - Phone:269-370-2899
Practice Address - Fax:269-350-5733
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009362101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health