Provider Demographics
NPI:1467869222
Name:MCCLELLAN, JYNNELL AKI
Entity Type:Individual
Prefix:
First Name:JYNNELL
Middle Name:AKI
Last Name:MCCLELLAN
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 1:9110 W LONE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-3563
Mailing Address - Country:US
Mailing Address - Phone:708-536-0507
Mailing Address - Fax:702-395-1108
Practice Address - Street 1:9110 W LONE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-3563
Practice Address - Country:US
Practice Address - Phone:708-536-0507
Practice Address - Fax:702-395-1108
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor