Provider Demographics
NPI:1487201802
Name:MCCLARTY, JOVAN E
Entity Type:Individual
Prefix:
First Name:JOVAN
Middle Name:E
Last Name:MCCLARTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 S HARMON ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-4969
Mailing Address - Country:US
Mailing Address - Phone:765-667-0173
Mailing Address - Fax:
Practice Address - Street 1:4008 S HARMON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4969
Practice Address - Country:US
Practice Address - Phone:765-667-0173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker