Provider Demographics
NPI:1407397599
Name:MCLEAN, TATIANA ASHLEY (LMHC)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:ASHLEY
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S COTTAGE ST APT 202
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6357
Mailing Address - Country:US
Mailing Address - Phone:631-357-7790
Mailing Address - Fax:
Practice Address - Street 1:2579 E 17TH ST STE 28
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3515
Practice Address - Country:US
Practice Address - Phone:347-708-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health