Provider Demographics
NPI:1225711344
Name:MCCLARY, KAELA
Entity Type:Individual
Prefix:
First Name:KAELA
Middle Name:
Last Name:MCCLARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71300 SAN JACINTO DR UNIT 1103
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4120
Mailing Address - Country:US
Mailing Address - Phone:347-790-3663
Mailing Address - Fax:
Practice Address - Street 1:473 E CARNEGIE DRIVE
Practice Address - Street 2:
Practice Address - City:SAN BERNADINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:760-237-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician