Provider Demographics
NPI:1184333510
Name:MCCLENON, MARTIN (LPC,LCDC)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:MCCLENON
Suffix:
Gender:M
Credentials:LPC,LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 STANFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUCAS
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1407
Mailing Address - Country:US
Mailing Address - Phone:214-235-8403
Mailing Address - Fax:972-363-2392
Practice Address - Street 1:1801 GATEWAY BLVD STE 219
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3626
Practice Address - Country:US
Practice Address - Phone:214-235-8403
Practice Address - Fax:972-363-2392
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15762101YA0400X
TX86636101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health