MEDICARE: MR. TIMMEY M MCCLURE JR. 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	101YM0800X	Mental Health Counselor	LPC3558	KS

General Provider Information

NPI Number	:	1083247118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMMEY M MCCLURE JR. LPC

Provider Business Mailing Address
First Line	:	3011 ANNA AVE
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-6519
Country	:	US
Telephone Number	:	620-408-4728
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 SAN JOSE ROOM 125 EAST
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2720
Country	:	US
Telephone Number	:	620-408-4728
Fax Number	:

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

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	05/13/2020

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