MEDICARE: CLINTON DENNARD M.S. 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	69403	TX

General Provider Information

NPI Number	:	1386908333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINTON DENNARD M.S. LPC

Provider Business Mailing Address
First Line	:	3500 HILLCREST DR STE 8
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-3144
Country	:	US
Telephone Number	:	254-262-3506
Fax Number	:	254-326-2350

Provider Business Practice Location Address
First Line	:	3500 HILLCREST DR STE 8
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-3144
Country	:	US
Telephone Number	:	254-262-3506
Fax Number	:	254-326-2350

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

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	12/21/2025

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