=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083459432
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. WILLIAM DOUGLAS MCCLURE II
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2024
-----------------------------------------------------
Last Update Date | 07/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13205 SW 137TH AVE STE 212
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-5335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-732-6298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8365 SW 152ND AVE APT 312C
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33193-4058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-367-0659
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-24-369833
-----------------------------------------------------
License Number State |
-----------------------------------------------------