Provider Demographics
NPI:1497052005
Name:MCCLAIN, ANGELA DIANE (LCPC, LCAC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DIANE
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:LCPC, LCAC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:PEAVY-BUTCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, LCAC
Mailing Address - Street 1:1601 S.W. 37TH STREET
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611
Mailing Address - Country:US
Mailing Address - Phone:785-228-5691
Mailing Address - Fax:785-272-1522
Practice Address - Street 1:1601 S.W 37TH STREET
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611
Practice Address - Country:US
Practice Address - Phone:785-228-5691
Practice Address - Fax:785-272-1522
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1021101YA0400X
KS1043101YA0400X
KS2506101YM0800X
NE1052101YM0800X
NE2014101YM0800X
IA001340101YM0800X
KS2329101YM0800X
KS536101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201086680AMedicaid