1073001780 NPI number — RACHEL MCCLURE LPCC-S

Table of content: RACHEL MCCLURE LPCC-S (NPI 1073001780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073001780 NPI number — RACHEL MCCLURE LPCC-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLURE
Provider First Name:
RACHEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073001780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2227
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LORAIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44054-0227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-223-7156
Provider Business Mailing Address Fax Number:
216-435-7363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 MILLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON LAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44012-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-331-5800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  C.1500293 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: E.1800701 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0282184 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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