Provider Demographics
NPI:1013146927
Name:MCCLELLAN, LANE ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:LANE
Middle Name:ELIZABETH
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 QUAIL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-7251
Mailing Address - Country:US
Mailing Address - Phone:662-844-0999
Mailing Address - Fax:
Practice Address - Street 1:1893 CLIFF GOOKIN BLVD STE B
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6558
Practice Address - Country:US
Practice Address - Phone:662-346-4584
Practice Address - Fax:662-346-4589
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC6938104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker