Healthcare Provider Details

I. General information

NPI: 1134570005
Provider Name (Legal Business Name): MARK MCCLURE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 S 6TH ST
KLAMATH FALLS OR
97603-4880
US

IV. Provider business mailing address

10906 MESA CT
KLAMATH FALLS OR
97601-9306
US

V. Phone/Fax

Practice location:
  • Phone: 541-671-3740
  • Fax: 541-275-0904
Mailing address:
  • Phone: 541-671-3740
  • Fax: 541-275-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5325
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: