Provider Demographics
NPI:1366116691
Name:MCCLENTON, MYCHAEL
Entity type:Individual
Prefix:
First Name:MYCHAEL
Middle Name:
Last Name:MCCLENTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4124
Mailing Address - Country:US
Mailing Address - Phone:352-277-7490
Mailing Address - Fax:
Practice Address - Street 1:17435 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6750
Practice Address - Country:US
Practice Address - Phone:352-434-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician