Provider Demographics
NPI:1447238290
Name:MCCLURE, JENNIFER M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5380 E KACHINA ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS MONTHAN A F B
Mailing Address - State:AZ
Mailing Address - Zip Code:85707-4923
Mailing Address - Country:US
Mailing Address - Phone:520-228-4926
Mailing Address - Fax:520-228-5283
Practice Address - Street 1:5380 E KACHINA ST
Practice Address - Street 2:
Practice Address - City:DAVIS MONTHAN A F B
Practice Address - State:AZ
Practice Address - Zip Code:85707-4923
Practice Address - Country:US
Practice Address - Phone:520-228-4926
Practice Address - Fax:520-228-5283
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0000000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical