Provider Demographics
NPI:1558563759
Name:MCCLAIN, VICKI DIANA (LPC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:DIANA
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10417 BLUE SPRUCE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-6725
Mailing Address - Country:US
Mailing Address - Phone:405-627-2034
Mailing Address - Fax:405-627-2034
Practice Address - Street 1:3233 E MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-7082
Practice Address - Country:US
Practice Address - Phone:405-603-3475
Practice Address - Fax:405-603-3475
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3214101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional