Healthcare Provider Details

I. General information

NPI: 1992118079
Provider Name (Legal Business Name): KYLE MCCLURE LCPC, LMAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E PRAIRIE CIR STE E
OLATHE KS
66062-5419
US

IV. Provider business mailing address

509 S VALLEY RD
OLATHE KS
66061-3918
US

V. Phone/Fax

Practice location:
  • Phone: 913-735-9444
  • Fax:
Mailing address:
  • Phone: 913-481-8132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2454
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number2454
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2454
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2549
License Number StateKS
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2549
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: