Basic Information
| Provider Information | |||||||||
| NPI: | 1518587385 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLURE | ||||||||
| FirstName: | MERCEDE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC CANDIDATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14700 E 88TH PL N APT 323 | ||||||||
| Address2: | |||||||||
| City: | OWASSO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740554936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188579846 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2325 S HARVARD AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741143300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185827228 | ||||||||
| FaxNumber: | 9183821881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2020 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101Y00000X | LPCCANDIDATE10738 | OK | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.