Basic Information
| Provider Information | |||||||||
| NPI: | 1043354400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLAIN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 730 WOOD ST | ||||||||
| Address2: | |||||||||
| City: | CROWN POINT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463074934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2196636348 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3903 INDIANAPOLIS BLVD | ||||||||
| Address2: | |||||||||
| City: | EAST CHICAGO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463122555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193987050 | ||||||||
| FaxNumber: | 2197571950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.