Provider Demographics
NPI:1457458754
Name:MCCLURE, KEVIN (LCPC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 NORTH UNIVERSITY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4763
Mailing Address - Country:US
Mailing Address - Phone:309-573-4834
Mailing Address - Fax:312-254-1423
Practice Address - Street 1:5016 NORTH UNIVERSITY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4763
Practice Address - Country:US
Practice Address - Phone:309-573-4834
Practice Address - Fax:312-254-1423
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-006803101YP2500X
IL180.006803101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional