Provider Demographics
NPI:1164524054
Name:MCCLINTOCK, PETE (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:PETE
Middle Name:
Last Name:MCCLINTOCK
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4906
Mailing Address - Country:US
Mailing Address - Phone:619-299-0975
Mailing Address - Fax:619-291-6738
Practice Address - Street 1:3411 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4906
Practice Address - Country:US
Practice Address - Phone:619-299-0975
Practice Address - Fax:619-291-6738
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health