Provider Demographics
NPI:1275283475
Name:MCCLELLAN, CASEY ALLEN (LAMFT)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:ALLEN
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 E WARNER RD STE 205
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3066
Mailing Address - Country:US
Mailing Address - Phone:480-702-1605
Mailing Address - Fax:480-452-0435
Practice Address - Street 1:1166 E WARNER RD
Practice Address - Street 2:205
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3066
Practice Address - Country:US
Practice Address - Phone:480-702-1605
Practice Address - Fax:480-452-0435
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10805106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist