Provider Demographics
NPI:1609021591
Name:MCLELLAN, JENIFER E (PSYCH TECH)
Entity Type:Individual
Prefix:MISS
First Name:JENIFER
Middle Name:E
Last Name:MCLELLAN
Suffix:
Gender:F
Credentials:PSYCH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 MADURO LN
Mailing Address - Street 2:PT G
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-5895
Mailing Address - Country:US
Mailing Address - Phone:707-291-7878
Mailing Address - Fax:
Practice Address - Street 1:9300 MADURO LN
Practice Address - Street 2:APT G
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5895
Practice Address - Country:US
Practice Address - Phone:707-291-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 14477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health