Provider Demographics
NPI:1174967830
Name:MCCLURE, ERIC DARNELL (MSW)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DARNELL
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8703 N FITZGERALD WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6737
Mailing Address - Country:US
Mailing Address - Phone:734-788-0557
Mailing Address - Fax:
Practice Address - Street 1:3600 KING RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-7140
Practice Address - Country:US
Practice Address - Phone:734-788-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010924251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11174967830Medicaid