Provider Demographics
NPI:1639374804
Name:MCCLELLAN, GLENN EARLE II (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:EARLE
Last Name:MCCLELLAN
Suffix:II
Gender:M
Credentials:PHD
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Mailing Address - Street 1:7423 E BLACKBERRY CV
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-4518
Mailing Address - Country:US
Mailing Address - Phone:714-289-8876
Mailing Address - Fax:714-544-4472
Practice Address - Street 1:14751 PLAZA DR
Practice Address - Street 2:SUITE F
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2702
Practice Address - Country:US
Practice Address - Phone:714-289-8876
Practice Address - Fax:714-544-4472
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY14169103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical