Provider Demographics
NPI:1194499533
Name:MCCLELLAN, ERIKA MARIE
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:MARIE
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 1:3543 MICHIGAN AVE APT 1N
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3642
Mailing Address - Country:US
Mailing Address - Phone:314-637-6004
Mailing Address - Fax:
Practice Address - Street 1:3543 MICHIGAN AVE APT 1N
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3642
Practice Address - Country:US
Practice Address - Phone:314-637-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021016978106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist