Provider Demographics
NPI:1235612995
Name:MCCLELLAN, ANGELA (LPCC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:CAIRL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:1144 S. DETROIT AVE.
Mailing Address - Street 2:PO BOX 141057
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-8300
Mailing Address - Country:US
Mailing Address - Phone:419-329-1658
Mailing Address - Fax:567-318-2429
Practice Address - Street 1:1715 INDIAN WOOD CIRCLE
Practice Address - Street 2:SUITE 200
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:567-318-2429
Practice Address - Fax:567-318-6569
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
OHE.2102600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0319475Medicaid