MEDICARE: NANCY CLARK MCCLURE 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	2624	WV

General Provider Information

NPI Number	:	1871262220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY CLARK MCCLURE LPC

Provider Business Mailing Address
First Line	:	PO BOX 363
Second Line	:
City	:	LOST CREEK
State	:	WV
Zip	:	26385-0363
Country	:	US
Telephone Number	:	304-626-5256
Fax Number	:

Provider Business Practice Location Address
First Line	:	613 W PIKE ST
Second Line	:
City	:	CLARKSBURG
State	:	WV
Zip	:	26301-2626
Country	:	US
Telephone Number	:	304-622-5323
Fax Number	:	304-622-5324

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

Provider Enumeration Date	:	09/09/2021
Last Update Date	:	09/09/2021

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