Provider Demographics
NPI:1356793608
Name:MCCLISH, DEBORAH L (LSAT, LISAC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:MCCLISH
Suffix:
Gender:F
Credentials:LSAT, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N TREKELL RD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-1770
Mailing Address - Country:US
Mailing Address - Phone:520-836-1029
Mailing Address - Fax:520-836-6733
Practice Address - Street 1:1901 N TREKELL RD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-1770
Practice Address - Country:US
Practice Address - Phone:520-836-1029
Practice Address - Fax:520-836-6733
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15098101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)