Provider Demographics
NPI:1740732593
Name:MCCLENAHAN, KATHY (MA)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:MCCLENAHAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15237 TRIESTE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6744
Mailing Address - Country:US
Mailing Address - Phone:321-297-0533
Mailing Address - Fax:
Practice Address - Street 1:1964 HOWELL BRANCH ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32732
Practice Address - Country:US
Practice Address - Phone:407-734-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 12394101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional