Active NPI
Mackenzie McClellan, TLLP
- Clinical Psychologist
- Warren, MI
National Provider Identifier
1003453200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301018169
- Practice address
- 8150 E 13 Mile Rd
Warren, MI 48093-8700 - Phone
- (586) 825-9700
- NPI assigned
- Dec 6, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301018169 | MI | Primary |
Addresses
Primary practice location
8150 E 13 Mile Rd
Warren, MI 48093-8700
Mailing address
6549 Town Center Dr Ste a
Clarkston, MI 48346-4824
Phone (248) 620-6400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301018169 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575590400000",
"number": "1003453200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6549 TOWN CENTER DR STE A",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483464824",
"telephone_number": "248-620-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8150 E 13 MILE RD",
"city": "WARREN",
"state": "MI",
"postal_code": "480938700",
"telephone_number": "586-825-9700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLELLAN",
"first_name": "MACKENZIE",
"credential": "TLLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-06",
"last_updated": "2019-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301018169",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warren, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.