Healthcare Provider Details

I. General information

NPI: 1467262386
Provider Name (Legal Business Name): KAYLEE ELIZABETH MCCLURE CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 HOGAN RD
BANGOR ME
04401-3626
US

IV. Provider business mailing address

1166 MAIN ST APT 1
OLD TOWN ME
04468-2023
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-0400
  • Fax: 207-973-1881
Mailing address:
  • Phone: 207-631-0591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC8737
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: