Provider Demographics
NPI:1144477399
Name:MCCLUNE, EDWARD (MFT)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:MCCLUNE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17219 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-3424
Mailing Address - Country:US
Mailing Address - Phone:707-996-4312
Mailing Address - Fax:
Practice Address - Street 1:19343 SONOMA HWY
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-5445
Practice Address - Country:US
Practice Address - Phone:707-996-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT38059106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist