1700996220 NPI number — TAMMY L MCCLAIN PSYD

Table of content: TAMMY L MCCLAIN PSYD (NPI 1700996220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700996220 NPI number — TAMMY L MCCLAIN PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLAIN
Provider First Name:
TAMMY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700996220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2219 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26070-1035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-914-2436
Provider Business Mailing Address Fax Number:
304-232-0719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 507
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-2726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-233-4600
Provider Business Practice Location Address Fax Number:
304-232-0719
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  854 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 5069 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000353399 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00164159 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2406480 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 716953000 . This is a "MAGELLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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