Provider Demographics
NPI:1346461837
Name:MCCLAREN, ADRIAN PAUL (LMFT)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:PAUL
Last Name:MCCLAREN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GOODMAN RD E STE 102
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-8313
Mailing Address - Country:US
Mailing Address - Phone:901-355-1770
Mailing Address - Fax:662-349-6626
Practice Address - Street 1:230 GOODMAN RD E STE 102
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-8313
Practice Address - Country:US
Practice Address - Phone:901-355-1770
Practice Address - Fax:662-349-6626
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST0167106H00000X
TNLMT000999106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN204866674OtherTAX ID