Provider Demographics
NPI:1598312803
Name:MCCLURE, JASON ALLEN (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALLEN
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 N MILPITAS BLVD # 419
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-4401
Mailing Address - Country:US
Mailing Address - Phone:669-467-9697
Mailing Address - Fax:
Practice Address - Street 1:1782 CLEAR LAKE AVE STE 248
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-7014
Practice Address - Country:US
Practice Address - Phone:669-467-9697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA11919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health