Provider Demographics
NPI:1346632957
Name:MCCLEARY, JOEL A (MS, MED)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:A
Last Name:MCCLEARY
Suffix:
Gender:M
Credentials:MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17815 WOODTHRUSH LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1329
Mailing Address - Country:US
Mailing Address - Phone:402-770-0464
Mailing Address - Fax:
Practice Address - Street 1:17815 WOODTHRUSH LN
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1329
Practice Address - Country:US
Practice Address - Phone:402-770-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC2-1963101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)