Provider Demographics
NPI:1154443398
Name:MCCLURE, REGINA M
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5256 SOUTH MISSION ROAD, SUITE 703
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003
Mailing Address - Country:US
Mailing Address - Phone:760-659-0413
Mailing Address - Fax:
Practice Address - Street 1:1204 LITTLE GOPHER CANYON ROAD
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084
Practice Address - Country:US
Practice Address - Phone:760-659-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist