Healthcare Provider Details

I. General information

NPI: 1982470787
Provider Name (Legal Business Name): MICHELLE MCCLURG MSW, CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/01/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E MAIN ST
MOREHEAD KY
40351-1622
US

IV. Provider business mailing address

2250 THUNDERSTICK DRIVE
MOREHEAD KY
40351-7642
US

V. Phone/Fax

Practice location:
  • Phone: 606-548-3850
  • Fax:
Mailing address:
  • Phone: 859-254-1035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6248
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: