MEDICARE: BONNIE MCCLURD 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	LPC013241	GA

General Provider Information

NPI Number	:	1740052901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE MCCLURD LPC

Provider Business Mailing Address
First Line	:	2751 LONG LAKE CT NE
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-4077
Country	:	US
Telephone Number	:	706-669-2801
Fax Number	:

Provider Business Practice Location Address
First Line	:	2751 LONG LAKE CT NE
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-4077
Country	:	US
Telephone Number	:	706-669-2801
Fax Number	:

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

Provider Enumeration Date	:	10/23/2023
Last Update Date	:	10/23/2023

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