Provider Demographics
NPI:1417047630
Name:MCLELLAN, ERIC D (LPCC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:D
Last Name:MCLELLAN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 E WHIPP RD STE A2
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-4239
Mailing Address - Country:US
Mailing Address - Phone:937-643-0091
Mailing Address - Fax:866-409-5783
Practice Address - Street 1:1948 E WHIPP RD STE A2
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-4239
Practice Address - Country:US
Practice Address - Phone:937-643-0091
Practice Address - Fax:866-409-5783
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3231101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH19432000OtherMAGELLAN
OH165435OtherCOMPSYCH
OH6280674OtherUBH
OH947770OtherCIGNA