Provider Demographics
NPI:1932408549
Name:MCLELLAN, RICHARD ALLEN (MS, LP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALLEN
Last Name:MCLELLAN
Suffix:
Gender:M
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7260 UNIVERSITY AVE NE
Mailing Address - Street 2:#235
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3126
Mailing Address - Country:US
Mailing Address - Phone:763-572-2605
Mailing Address - Fax:763-572-2606
Practice Address - Street 1:7260 UNIVERSITY AVE NE
Practice Address - Street 2:#235
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3126
Practice Address - Country:US
Practice Address - Phone:763-572-2605
Practice Address - Fax:763-572-2606
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0295103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical