Provider Demographics
NPI:1932414307
Name:MCCLELLAN, BRANDI L
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:L
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 69 BOX 578
Mailing Address - Street 2:
Mailing Address - City:FINLEY
Mailing Address - State:OK
Mailing Address - Zip Code:74543-9642
Mailing Address - Country:US
Mailing Address - Phone:580-298-9963
Mailing Address - Fax:
Practice Address - Street 1:HC 69 BOX 578
Practice Address - Street 2:
Practice Address - City:FINLEY
Practice Address - State:OK
Practice Address - Zip Code:74543-9642
Practice Address - Country:US
Practice Address - Phone:580-298-9963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation