Basic Information
| Provider Information | |||||||||
| NPI: | 1730162504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLYMORE | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | MCCULLOCH | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PLATTSBURG | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644771238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165393080 | ||||||||
| FaxNumber: | 8165392866 | ||||||||
| Practice Location | |||||||||
| Address1: | 214 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PLATTSBURG | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644771238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165393080 | ||||||||
| FaxNumber: | 8165392866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 005907 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 25530011 | 01 | MO | BLUE CROSS OF KANSAS CITY | OTHER | 10001370500 | 01 | MO | COMMUNITY HEALTH PLAN | OTHER |