Basic Information
| Provider Information | |||||||||
| NPI: | 1871982926 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLENDON | ||||||||
| FirstName: | MIRAN | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | LCADC, LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597570717 | ||||||||
| FaxNumber: | 8593312425 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 CENTRE VIEW BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597570717 | ||||||||
| FaxNumber: | 8593312425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2015 | ||||||||
| LastUpdateDate: | 12/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/12/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 165248 | KY | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 172295 | KY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.