Provider Demographics
NPI:1710451646
Name:MCCLURE, SEAN L (MSE, PLMHP)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:L
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:MSE, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63320 733 RD
Mailing Address - Street 2:
Mailing Address - City:BROCK
Mailing Address - State:NE
Mailing Address - Zip Code:68320-3031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2725 N HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:NE
Practice Address - Zip Code:68450-9589
Practice Address - Country:US
Practice Address - Phone:402-335-5106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health