Provider Demographics
NPI:1225307911
Name:MCCLOW, DAVID (MDIV, LMFT, LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:MCCLOW
Suffix:
Gender:M
Credentials:MDIV, LMFT, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 S LEE ST
Mailing Address - Street 2:
Mailing Address - City:GARRETT
Mailing Address - State:IN
Mailing Address - Zip Code:46738-1578
Mailing Address - Country:US
Mailing Address - Phone:260-357-6429
Mailing Address - Fax:260-357-6429
Practice Address - Street 1:513 S LEE ST
Practice Address - Street 2:
Practice Address - City:GARRETT
Practice Address - State:IN
Practice Address - Zip Code:46738-1578
Practice Address - Country:US
Practice Address - Phone:260-357-6429
Practice Address - Fax:260-357-6429
Is Sole Proprietor?:No
Enumeration Date:2011-12-24
Last Update Date:2011-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003044A1041C0700X
IN35000959A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical