Provider Demographics
NPI:1811061864
Name:MCCLURE, STEPHEN GARY (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GARY
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 SUNRISE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4565
Mailing Address - Country:US
Mailing Address - Phone:916-782-3800
Mailing Address - Fax:916-782-3820
Practice Address - Street 1:729 SUNRISE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4565
Practice Address - Country:US
Practice Address - Phone:916-782-3800
Practice Address - Fax:916-782-3820
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL135720Medicare ID - Type UnspecifiedMEDICARE