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Individual

DR. MARY JANE MCLELLAN

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
PH.D

Contact information

Practice address
2415 W KILTIE LN, FLAGSTAFF, AZ 86001-9107
(928) 774-3086
(928) 213-8507
Mailing address
2415 W KILTIE LN, FLAGSTAFF, AZ 86001-9107
(928) 774-3086
(928) 213-8507

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
1077
VA
103T00000X
Psychologist
Primary
3087
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
361650
AZ
Enumeration date
07/01/2005
Last updated
07/09/2007
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