Provider Demographics
NPI:1730162504
Name:CLYMORE, REBECCA MCCULLOCH (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MCCULLOCH
Last Name:CLYMORE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64477-1238
Mailing Address - Country:US
Mailing Address - Phone:816-539-3080
Mailing Address - Fax:816-539-2866
Practice Address - Street 1:214 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURG
Practice Address - State:MO
Practice Address - Zip Code:64477-1238
Practice Address - Country:US
Practice Address - Phone:816-539-3080
Practice Address - Fax:816-539-2866
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0059071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25530011OtherBLUE CROSS OF KANSAS CITY
MO10001370500OtherCOMMUNITY HEALTH PLAN
MO10001370500OtherCOMMUNITY HEALTH PLAN