Provider Demographics
NPI:1881750933
Name:MCCLEESE, JUDITH B (MFT)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:B
Last Name:MCCLEESE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3172 RUBIO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-1522
Mailing Address - Country:US
Mailing Address - Phone:626-794-9056
Mailing Address - Fax:626-791-7059
Practice Address - Street 1:92 N MADISON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1740
Practice Address - Country:US
Practice Address - Phone:626-791-7059
Practice Address - Fax:626-791-7059
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMA18462106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist