Provider Demographics
NPI:1104223718
Name:MCCLUNG, PAUL RICHARD JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RICHARD
Last Name:MCCLUNG
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:MCCLUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:3581 HARRODSBURG RD STE 350
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1140
Practice Address - Country:US
Practice Address - Phone:859-313-6333
Practice Address - Fax:859-313-3484
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1817104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid
KY7100322400Medicaid