Provider Demographics
NPI:1548641103
Name:MCCLELLAN, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 S SEPULVEDA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3605
Mailing Address - Country:US
Mailing Address - Phone:209-319-2172
Mailing Address - Fax:310-945-3355
Practice Address - Street 1:8939 S SEPULVEDA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3605
Practice Address - Country:US
Practice Address - Phone:209-319-2172
Practice Address - Fax:310-945-3355
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74106106H00000X
CA122543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist