Provider Demographics
NPI:1316992803
Name:MCCLINTOCK, KAREN AGALIA (PHD PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:AGALIA
Last Name:MCCLINTOCK
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:149 CLEAR CREEK DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1882
Mailing Address - Country:US
Mailing Address - Phone:541-326-1616
Mailing Address - Fax:
Practice Address - Street 1:149 CLEAR CREEK DR UNIT 101
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1882
Practice Address - Country:US
Practice Address - Phone:541-326-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#1522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR134706Medicare PIN