Healthcare Provider Details

I. General information

NPI: 1306288477
Provider Name (Legal Business Name): RACHEL MARIE MCCLURE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 HAMPTON LN NW APT 2A
WALKER MI
49534-7808
US

IV. Provider business mailing address

528 HAMPTON LN NW APT 2A
WALKER MI
49534-7808
US

V. Phone/Fax

Practice location:
  • Phone: 231-590-3297
  • Fax:
Mailing address:
  • Phone: 231-590-3297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095397
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: