Provider Demographics
NPI:1962682278
Name:MCLEAN, CHRISTOPHER RUSSELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RUSSELL
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TANG CENTER -- 2222 BANCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4300
Mailing Address - Country:US
Mailing Address - Phone:510-643-2901
Mailing Address - Fax:510-642-2368
Practice Address - Street 1:TANG CENTER -- 2222 BANCROFT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4300
Practice Address - Country:US
Practice Address - Phone:510-643-2901
Practice Address - Fax:510-642-2368
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14796103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling