Provider Demographics
NPI:1609509504
Name:MCCLIMANS, MATTHEW THANE (LMSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THANE
Last Name:MCCLIMANS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CARRIAGE LN N APT 1006
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-2943
Mailing Address - Country:US
Mailing Address - Phone:208-308-8686
Mailing Address - Fax:
Practice Address - Street 1:625 POLE LINE RD W STE 2A
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4270
Practice Address - Country:US
Practice Address - Phone:208-814-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID42417104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker