Provider Demographics
NPI:1205847605
Name:MCCLINTON, LAURA M (LMFT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:MCCLINTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 CHESTNUT ST STE 403
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4304
Mailing Address - Country:US
Mailing Address - Phone:215-732-2306
Mailing Address - Fax:215-807-0958
Practice Address - Street 1:1015 CHESTNUT ST STE 403
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4304
Practice Address - Country:US
Practice Address - Phone:215-732-2306
Practice Address - Fax:215-807-0958
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAMF000905106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health