Provider Demographics
NPI:1548422702
Name:MCCLELLAND, GUS (MSW)
Entity Type:Individual
Prefix:
First Name:GUS
Middle Name:
Last Name:MCCLELLAND
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 EUCLID
Mailing Address - Street 2:CAMERON OUTPATIENT CLINIC
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429
Mailing Address - Country:US
Mailing Address - Phone:816-632-5312
Mailing Address - Fax:816-632-1962
Practice Address - Street 1:4801 LINWOOD BLVD
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128
Practice Address - Country:US
Practice Address - Phone:816-632-5312
Practice Address - Fax:816-632-1962
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2272104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker