Provider Demographics
NPI:1811552987
Name:MCCLENDON, LEVI (PHD, LPC, RPT)
Entity Type:Individual
Prefix:DR
First Name:LEVI
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:M
Credentials:PHD, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 CLOVE HITCH RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2089
Mailing Address - Country:US
Mailing Address - Phone:512-763-7294
Mailing Address - Fax:
Practice Address - Street 1:1049 CLOVE HITCH RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-2089
Practice Address - Country:US
Practice Address - Phone:512-763-7294
Practice Address - Fax:512-564-8066
Is Sole Proprietor?:No
Enumeration Date:2019-05-04
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health