Provider Demographics
NPI:1619316833
Name:MCCLELLAN, STACEY LOUISE
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LOUISE
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 1:8136 GRAY CT APT 511
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-1858
Mailing Address - Country:US
Mailing Address - Phone:561-504-1000
Mailing Address - Fax:
Practice Address - Street 1:155 INVERNESS DR W
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5095
Practice Address - Country:US
Practice Address - Phone:561-504-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health