Provider Demographics
NPI:1114410271
Name:MCCLAIN, RODRIC MONTRELL (LIMHP)
Entity Type:Individual
Prefix:MR
First Name:RODRIC
Middle Name:MONTRELL
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10016 S 186TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-6493
Mailing Address - Country:US
Mailing Address - Phone:580-647-5866
Mailing Address - Fax:
Practice Address - Street 1:324 S 9TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2215
Practice Address - Country:US
Practice Address - Phone:402-261-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2617101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional