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General NPI Number Information
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NPI Number | 1942782909
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Entity Type | Individual
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Provider Name | DANIEL ROBERT MCCLURE PSYD, LP
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Gender | Male
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 557 7TH ST W
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City | SAINT PAUL
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State | MN
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Zip | 55102-3065
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Country | US
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Telephone | 651-587-1807
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Fax |
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Provider Business Mailing Address
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Address Line | 616 SUMMIT AVE APT 204
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City | SAINT PAUL
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State | MN
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Zip | 55102-2669
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Country | US
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Telephone | 651-260-9246
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP6487
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License Number State | MN
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