Provider Demographics
NPI:1902131477
Name:MCCLELLAND, HEATHER (LPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5367 STONEBRIAR CIR
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-1702
Mailing Address - Country:US
Mailing Address - Phone:580-371-3672
Mailing Address - Fax:580-371-3651
Practice Address - Street 1:5367 STONEBRIAR CIR
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-1702
Practice Address - Country:US
Practice Address - Phone:580-371-3672
Practice Address - Fax:580-371-3651
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
OK4219101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional