Provider Demographics
NPI:1780444984
Name:MCCLOUD, KRISTIN DEEANN (LMSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DEEANN
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 WESTLAWN BLVD APT 421
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-1797
Mailing Address - Country:US
Mailing Address - Phone:731-819-4644
Mailing Address - Fax:
Practice Address - Street 1:2650 MEMORIAL BLVD STE E
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-5138
Practice Address - Country:US
Practice Address - Phone:731-819-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000013152104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker