Provider Demographics
NPI:1861645368
Name:MCCLAIN, MICHAEL LANE (MA, RRT, CADC, CPRM)
Entity Type:Individual
Prefix:PROF
First Name:MICHAEL
Middle Name:LANE
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:MA, RRT, CADC, CPRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2857
Mailing Address - Country:US
Mailing Address - Phone:313-365-3100
Mailing Address - Fax:
Practice Address - Street 1:1121 E MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-2857
Practice Address - Country:US
Practice Address - Phone:313-365-3100
Practice Address - Fax:313-864-5326
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1861645368101YA0400X, 175T00000X
MI2279E1000X
MI822974101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
No2279E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEducational