Provider Demographics
NPI:1245737584
Name:MCCLINTON, EBONY
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:MCCLINTON
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 1:396 E SOUTHWEST PKWY APT 2526
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6353
Mailing Address - Country:US
Mailing Address - Phone:318-286-1379
Mailing Address - Fax:
Practice Address - Street 1:201 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-2067
Practice Address - Country:US
Practice Address - Phone:318-286-1379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health