Individual
MARYELLEN KATHERINE BRUNSON MCCLAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD-LP
Contact information
Practice address
6405 OLD MAIN HILL, LOGAN, UT 84322-0001
(435) 797-1346
(844) 308-5865
Mailing address
6410 OLD MAIN HL, LOGAN, UT 84322-6410
(435) 797-1346
(844) 308-5865
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10464447-2501
LICENSE
UT
Enumeration date
05/08/2019
Last updated
05/08/2019
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