Basic Information
| Provider Information | |||||||||
| NPI: | 1104138148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLAIN | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10011 SE DIVISION ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972661354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032552343 | ||||||||
| FaxNumber: | 5032552344 | ||||||||
| Practice Location | |||||||||
| Address1: | 10011 SE DIVISION ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972661354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032552343 | ||||||||
| FaxNumber: | 5032552344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2010 | ||||||||
| LastUpdateDate: | 03/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103TC0700X | 2268 | OR | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | R0000WDBCH | 01 | MEDICARE GROUP | OTHER | 164936 | 05 | OR | MEDICAID |