Provider Demographics
NPI:1275862534
Name:MCCLENDON, MICHAELANGELO (LMHCA)
Entity Type:Individual
Prefix:MR
First Name:MICHAELANGELO
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4095 POINT BAR RD APT 1C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3774
Mailing Address - Country:US
Mailing Address - Phone:240-353-9275
Mailing Address - Fax:
Practice Address - Street 1:4095 POINT BAR RD APT 1C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3774
Practice Address - Country:US
Practice Address - Phone:240-353-9275
Practice Address - Fax:317-222-4294
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99123093A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200960560Medicaid
IN853975967OtherMENTAL HEALTH COUNSELING