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Individual

DERECK MCCLENDON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2454 W LISBON AVE, MILWAUKEE, WI 53205-1413
(414) 562-6361
(414) 204-8689
Mailing address
2454 W LISBON AVE, MILWAUKEE, WI 53205-1413
(414) 562-6361
(414) 204-8689

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
WI
101YM0800X
Mental Health Counselor
WI
101YP2500X
Professional Counselor
WI

Other

Enumeration date
10/03/2016
Last updated
10/03/2016
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