Provider Demographics
NPI:1518587385
Name:MCCLURE, MERCEDE (LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:MERCEDE
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14700 E 88TH PL N APT 323
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4936
Mailing Address - Country:US
Mailing Address - Phone:918-857-9846
Mailing Address - Fax:
Practice Address - Street 1:2325 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3300
Practice Address - Country:US
Practice Address - Phone:918-582-7228
Practice Address - Fax:918-382-1881
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OKLPCCANDIDATE10738101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator