Provider Demographics
NPI:1366675126
Name:MCCLENNEY, JOYCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:
Last Name:MCCLENNEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LAKE
Other - Middle Name:
Other - Last Name:MCCLENNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1747 VISTA DEL LAGO
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-1749
Mailing Address - Country:US
Mailing Address - Phone:760-723-9683
Mailing Address - Fax:760-723-9683
Practice Address - Street 1:1747 VISTA DEL LAGO
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-1749
Practice Address - Country:US
Practice Address - Phone:707-538-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10965103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical