MEDICARE: MR. ANDREW HERRICK MCCLURE MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC 41078	CA

General Provider Information

NPI Number	:	1083771299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW HERRICK MCCLURE MFT

Provider Business Mailing Address
First Line	:	420 E CANAL DR
Second Line	:
City	:	TURLOCK
State	:	CA
Zip	:	95380-3936
Country	:	US
Telephone Number	:	209-669-2583
Fax Number	:	209-656-1487

Provider Business Practice Location Address
First Line	:	420 E CANAL DR
Second Line	:
City	:	TURLOCK
State	:	CA
Zip	:	95380-3936
Country	:	US
Telephone Number	:	209-669-2583
Fax Number	:	209-656-1487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	02/11/2022

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