Provider Demographics
NPI:1245773696
Name:MCCLELLAND, CRYSTAL J (LMFT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:J
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:WHITACRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20351 SW ACACIA ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1527
Mailing Address - Country:US
Mailing Address - Phone:877-844-8783
Mailing Address - Fax:
Practice Address - Street 1:2601 E CHAPMAN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3737
Practice Address - Country:US
Practice Address - Phone:949-702-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124435106H00000X
174V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174V00000XOther Service ProvidersClinical Ethicist