Provider Demographics
NPI:1164219499
Name:MCLAREN, MARY (NCSP, CRC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCLAREN
Suffix:
Gender:F
Credentials:NCSP, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-2335
Mailing Address - Country:US
Mailing Address - Phone:712-249-0478
Mailing Address - Fax:
Practice Address - Street 1:1309 ELM ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-2335
Practice Address - Country:US
Practice Address - Phone:712-249-0478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1022600103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool