Provider Demographics
NPI:1487880001
Name:MCCLURE, JAIME LEA (LISW)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:LEA
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 42ND ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-2701
Mailing Address - Country:US
Mailing Address - Phone:515-255-8399
Mailing Address - Fax:515-255-8405
Practice Address - Street 1:600 42ND ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-2701
Practice Address - Country:US
Practice Address - Phone:515-255-8399
Practice Address - Fax:515-255-8405
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007728101YM0800X
IA00124101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0469676Medicaid