Provider Demographics
NPI:1629578950
Name:LUCHENBACH-MCCLELLAN, ALEXANDRIA (LLMFT)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:LUCHENBACH-MCCLELLAN
Suffix:
Gender:F
Credentials:LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26555 EVERGREEN RD STE 870
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4239
Mailing Address - Country:US
Mailing Address - Phone:248-430-0594
Mailing Address - Fax:
Practice Address - Street 1:26555 EVERGREEN RD STE 870
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4239
Practice Address - Country:US
Practice Address - Phone:248-430-0594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4151001146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist