Healthcare Provider Details

I. General information

NPI: 1639612237
Provider Name (Legal Business Name): DEBRA MCCLINTOCK MSW LCSW -PIP QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 06/08/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48575 267TH ST
VALLEY SPRINGS SD
57068
US

IV. Provider business mailing address

48575 267TH ST
VALLEY SPRINGS SD
57068-7322
US

V. Phone/Fax

Practice location:
  • Phone: 605-759-4290
  • Fax:
Mailing address:
  • Phone: 605-759-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6061
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3468
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4773
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106722
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29540
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: