Provider Demographics
NPI:1295010320
Name:MCCLURG-GENEVESE, THERESA CORINNE (LPC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:CORINNE
Last Name:MCCLURG-GENEVESE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 RAVINES EDGE CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5423
Mailing Address - Country:US
Mailing Address - Phone:614-896-8222
Mailing Address - Fax:614-896-8223
Practice Address - Street 1:8001 RAVINES EDGE CT
Practice Address - Street 2:SUITE 201
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5423
Practice Address - Country:US
Practice Address - Phone:614-896-8222
Practice Address - Fax:614-896-8223
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0900494101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health