Provider Demographics
NPI:1639630411
Name:MCCLELLAND, BROOKE MEGAN (LAC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MEGAN
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-3633
Mailing Address - Country:US
Mailing Address - Phone:510-410-0635
Mailing Address - Fax:
Practice Address - Street 1:1840 EMBARCADERO
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5220
Practice Address - Country:US
Practice Address - Phone:510-463-4304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18249171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty