Provider Demographics
NPI:1851582183
Name:MCKAIN, JOHN W (UNDER LICENSE SUPERV)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:MCKAIN
Suffix:
Gender:M
Credentials:UNDER LICENSE SUPERV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-6203
Mailing Address - Country:US
Mailing Address - Phone:918-585-9888
Mailing Address - Fax:918-585-5678
Practice Address - Street 1:1629 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-6203
Practice Address - Country:US
Practice Address - Phone:918-585-9888
Practice Address - Fax:918-585-5678
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKUNDER SUPERVISION101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)