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General NPI Number Information
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NPI Number | 1093070740
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Entity Type | Individual
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Provider Name | COLLIN O. MCCLOY LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 501 S BURMA AVE
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City | GILLETTE
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State | WY
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Zip | 82716-3426
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Country | US
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Telephone | 307-688-5000
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Fax | 307-688-5015
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Provider Business Mailing Address
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Address Line | 501 S BURMA AVE
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City | GILLETTE
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State | WY
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Zip | 82716-3426
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Country | US
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Telephone | 307-688-5000
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Fax | 307-688-5015
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 455
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License Number State | WY
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