Provider Demographics
NPI:1942782909
Name:MCCLURE, DANIEL ROBERT (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 SUMMIT AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2669
Mailing Address - Country:US
Mailing Address - Phone:651-260-9246
Mailing Address - Fax:
Practice Address - Street 1:557 7TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3065
Practice Address - Country:US
Practice Address - Phone:651-587-1807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6487103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical