Provider Demographics
NPI:1467079160
Name:MCCLENAHAN, ABBE
Entity Type:Individual
Prefix:
First Name:ABBE
Middle Name:
Last Name:MCCLENAHAN
Suffix:
Gender:F
Credentials:
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 9331
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92652-7318
Mailing Address - Country:US
Mailing Address - Phone:949-246-2822
Mailing Address - Fax:
Practice Address - Street 1:30200 RANCHO VIEJO RD STE D
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1560
Practice Address - Country:US
Practice Address - Phone:657-224-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist