Provider Demographics
NPI:1548794852
Name:MCCLUNG, TANYA LISETTE
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LISETTE
Last Name:MCCLUNG
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 1:313 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-2629
Mailing Address - Country:US
Mailing Address - Phone:304-952-0064
Mailing Address - Fax:
Practice Address - Street 1:313 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-2629
Practice Address - Country:US
Practice Address - Phone:304-952-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor