Provider Demographics
NPI:1376626200
Name:MCCLURE, REGINA B (LCPC, NCSP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:B
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LCPC, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20650 S CICERO AVE UNIT 613
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3424
Mailing Address - Country:US
Mailing Address - Phone:872-228-5434
Mailing Address - Fax:
Practice Address - Street 1:1805 W MONTEREY AVE STE 146273
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4228
Practice Address - Country:US
Practice Address - Phone:312-834-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP1600X
IL180006074103TB0200X
IN1035218103TS0200X
IL1911832103TS0200X
IL180-0066064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool