Provider Demographics
NPI:1629400015
Name:MCLEOD, CLARISSE LIANNE
Entity Type:Individual
Prefix:MS
First Name:CLARISSE
Middle Name:LIANNE
Last Name:MCLEOD
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 1:1560 LOMA DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3711
Mailing Address - Country:US
Mailing Address - Phone:805-910-8559
Mailing Address - Fax:
Practice Address - Street 1:1560 LOMA DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3711
Practice Address - Country:US
Practice Address - Phone:805-910-8559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist