Provider Demographics
NPI:1497921894
Name:MCLELLAN, AUTUMN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:MCLELLAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 OLD FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-2031
Mailing Address - Country:US
Mailing Address - Phone:814-882-0046
Mailing Address - Fax:814-528-5010
Practice Address - Street 1:3858 WALKER BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1627
Practice Address - Country:US
Practice Address - Phone:814-882-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004866106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist