Provider Demographics
NPI:1114697190
Name:MCCLASKEY, KIM IRENE
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:IRENE
Last Name:MCCLASKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20051 SW BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1719
Mailing Address - Country:US
Mailing Address - Phone:213-924-6442
Mailing Address - Fax:
Practice Address - Street 1:20051 SW BIRCH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1719
Practice Address - Country:US
Practice Address - Phone:213-924-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)