Most Relevant Information
Provider Data
| NPI Number: | 1003453200 |
| Provider Name: | MACKENZIE MCCLELLAN TLLP |
| Entity Type: | Individual |
| Taxonomy Code: | 103TC0700X |
| Specialty: | Psychologist |
| License Number: | 6301018169 |
Most Important Dates
| Enumeration Date: | 12/06/2019 |
| Last Updated: | 12/06/2019 |
Provider Practice Location
8150 E 13 MILE RD
WARREN
MI
480938700
Practice Location Phone/Fax
| Phone: | 5868259700 |
| Fax: |
Provider Mailing Location
6549 TOWN CENTER DR STE A
CLARKSTON
MI
483464824
Provider Mailing Phone/Fax
| Phone: | 2486206400 |
| Fax: |