Provider Demographics
NPI:1134570005
Name:MCCLURE, MARK (LPC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 MAIN ST STE 512
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6062
Mailing Address - Country:US
Mailing Address - Phone:541-851-6156
Mailing Address - Fax:541-833-6249
Practice Address - Street 1:905 MAIN ST STE 512
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6062
Practice Address - Country:US
Practice Address - Phone:541-851-6156
Practice Address - Fax:541-833-6249
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5325101YM0800X, 101YP2500X
101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional