Individual
MARY L. MCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1605 S 31ST STREET, TEMPLE, TX 76508-0001
(254) 215-0100
(254) 215-0636
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT03391
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8U3091
BLUE SHIELD
TX
Enumeration date
04/08/2006
Last updated
01/25/2022
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