Provider Demographics
NPI:1639612237
Name:MCCLINTOCK, DEBRA (MSW LCSW -PIP QMHP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:MCCLINTOCK
Suffix:
Gender:F
Credentials:MSW LCSW -PIP QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48575 267TH ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57068-7322
Mailing Address - Country:US
Mailing Address - Phone:605-759-4290
Mailing Address - Fax:
Practice Address - Street 1:48575 267TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57068
Practice Address - Country:US
Practice Address - Phone:605-759-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND60611041C0700X
SD34681041C0700X
SD47731041C0700X
IA1067221041C0700X
MN295401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical