Provider Demographics
NPI:1275374381
Name:MCCLINTOCK, BARRY JAY (PLPC)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:JAY
Last Name:MCCLINTOCK
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-1704
Mailing Address - Country:US
Mailing Address - Phone:314-315-7838
Mailing Address - Fax:
Practice Address - Street 1:8949 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2621
Practice Address - Country:US
Practice Address - Phone:314-329-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022042469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health