Provider Demographics
NPI:1932487485
Name:MCCLURE-OLIVER, LEANNE (MA)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:MCCLURE-OLIVER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:NUGENT
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 N FREDONIA ST STE 122
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6466
Mailing Address - Country:US
Mailing Address - Phone:903-242-8534
Mailing Address - Fax:
Practice Address - Street 1:409 N FREDONIA ST STE 122
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6466
Practice Address - Country:US
Practice Address - Phone:903-242-8534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36098103T00000X
101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool