Provider Demographics
NPI:1942743851
Name:MACLEAN, CONSTANCEATHENA (PHD, LPC, CFT)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCEATHENA
Middle Name:
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:PHD, LPC, CFT
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:BOWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:961 HOUSE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:TX
Mailing Address - Zip Code:76856-6550
Mailing Address - Country:US
Mailing Address - Phone:325-347-7088
Mailing Address - Fax:
Practice Address - Street 1:961 HOUSE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:TX
Practice Address - Zip Code:76856-6550
Practice Address - Country:US
Practice Address - Phone:325-347-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-24
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH260296163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health