Active NPI
Glenn Earle McClellan II, PH.D.
- Clinical Psychologist
- Tustin, CA
National Provider Identifier
1639374804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY14169
- Practice address
- 14751 Plaza Dr
Suite F
Tustin, CA 92780-2702 - Phone
- (714) 289-8876
- Fax
- (714) 544-4472
- NPI assigned
- Jun 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | PSY14169 | CA | Primary |
Addresses
Primary practice location
14751 Plaza Dr
Suite F
Tustin, CA 92780-2702
Mailing address
7423 E Blackberry CV
Orange, CA 92869-4518
Phone (714) 289-8876
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY14169 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inner Peace Psychotherapy, PC | Past | Accepting new patients | |
| Pointer Psychotherapy, Inc | Clinical | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Tustin, CA
- NPI 1598179814
-
- Clinical Psychologist
- Tustin, CA
- NPI 1962984013
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639374804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7423 E BLACKBERRY CV",
"city": "ORANGE",
"state": "CA",
"postal_code": "928694518",
"telephone_number": "714-289-8876",
"fax_number": "714-544-4472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14751 PLAZA DR",
"address_2": "SUITE F",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927802702",
"telephone_number": "714-289-8876",
"fax_number": "714-544-4472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLELLAN",
"first_name": "GLENN",
"middle_name": "EARLE",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY14169",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.