Provider Demographics
NPI:1083247118
Name:MCCLURE, TIMMEY M JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:TIMMEY
Middle Name:M
Last Name:MCCLURE
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 ANNA AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-6519
Mailing Address - Country:US
Mailing Address - Phone:620-408-4728
Mailing Address - Fax:
Practice Address - Street 1:236 SAN JOSE ROOM 125 EAST
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2720
Practice Address - Country:US
Practice Address - Phone:620-408-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC3558101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health