Provider Demographics
NPI:1235750399
Name:MCCLATCHY, STEVEN KENT
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:KENT
Last Name:MCCLATCHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2442
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-7442
Mailing Address - Country:US
Mailing Address - Phone:469-248-7619
Mailing Address - Fax:
Practice Address - Street 1:4106 YANA CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-7581
Practice Address - Country:US
Practice Address - Phone:469-248-7619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75860OtherLPC LICENSE
TX09981682OtherDRIVERS LICENSE
ARP2306027OtherLPC LICENSE