Provider Demographics
NPI:1225152002
Name:MCLAIN, MELISSA KRISTINE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KRISTINE
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KRISTINE
Other - Last Name:HOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 N 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-1430
Mailing Address - Country:US
Mailing Address - Phone:309-344-4236
Mailing Address - Fax:309-344-4281
Practice Address - Street 1:2725 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2634
Practice Address - Country:US
Practice Address - Phone:662-449-1971
Practice Address - Fax:662-449-1974
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MS2977101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370984175OtherFEIN ORGANIZATION