MEDICARE: DEREK H MCCLURE MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2012008595	MO

General Provider Information

NPI Number	:	1023401205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK H MCCLURE MA, LPC

Provider Business Mailing Address
First Line	:	2885 W BATTLEFIELD ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-3952
Country	:	US
Telephone Number	:	417-761-5214
Fax Number	:	417-761-5065

Provider Business Practice Location Address
First Line	:	90 E LESLIE LN
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-1589
Country	:	US
Telephone Number	:	573-875-8880
Fax Number	:	573-442-3830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	04/09/2025

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