Provider Demographics
NPI:1366570137
Name:MCCLELLAN-MOREHOUSE, MARTHA (LMFT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:MCCLELLAN-MOREHOUSE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARTI
Other - Middle Name:
Other - Last Name:MCCLELLAN-MOREHOUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:5150 FAIR OAKS BLVD # 101-221
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5758
Mailing Address - Country:US
Mailing Address - Phone:626-755-7385
Mailing Address - Fax:
Practice Address - Street 1:3436 AMERICAN RIVER DR STE 4
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5793
Practice Address - Country:US
Practice Address - Phone:626-755-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT43084106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist