Provider Demographics
NPI:1821745100
Name:MCCLAIN, RICHADEENA
Entity Type:Individual
Prefix:MRS
First Name:RICHADEENA
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DEE
Other - Middle Name:
Other - Last Name:MCCLAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:304 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-4059
Mailing Address - Country:US
Mailing Address - Phone:580-271-8851
Mailing Address - Fax:
Practice Address - Street 1:304 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-4059
Practice Address - Country:US
Practice Address - Phone:580-271-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator