Provider Demographics
NPI:1407299654
Name:MCLEAN-NICHOLAS, TANIA H (LMFT)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:H
Last Name:MCLEAN-NICHOLAS
Suffix:
Gender:F
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:PO BOX 891592
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-1592
Mailing Address - Country:US
Mailing Address - Phone:951-551-3799
Mailing Address - Fax:951-346-3727
Practice Address - Street 1:41690 ENTERPRISE CIRCLE NORTH
Practice Address - Street 2:100
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5617
Practice Address - Country:US
Practice Address - Phone:951-551-3799
Practice Address - Fax:951-346-3727
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist