Provider Demographics
NPI:1649375825
Name:MCCLURE, BRUCE EDWARD (PHD, LCPC,NCC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:EDWARD
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:PHD, LCPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4807
Mailing Address - Country:US
Mailing Address - Phone:301-333-5150
Mailing Address - Fax:301-333-5161
Practice Address - Street 1:7800 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4807
Practice Address - Country:US
Practice Address - Phone:301-333-5150
Practice Address - Fax:301-333-5161
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD46790101YM0800X
MDLC0718101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11613455OtherCAQH ID