Provider Demographics
NPI:1659624260
Name:MCLELLAN, CORTNEY A (LPC)
Entity Type:Individual
Prefix:MS
First Name:CORTNEY
Middle Name:A
Last Name:MCLELLAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:A
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12004 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-1510
Mailing Address - Country:US
Mailing Address - Phone:989-573-8225
Mailing Address - Fax:
Practice Address - Street 1:12004 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-1510
Practice Address - Country:US
Practice Address - Phone:989-573-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019830101YM0800X
MI7501001555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist