Provider Demographics
NPI:1265083125
Name:MCCLOUD, ADAM BLAKE (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:BLAKE
Last Name:MCCLOUD
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 OLD SNAPPS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:CHUCKEY
Mailing Address - State:TN
Mailing Address - Zip Code:37641-4241
Mailing Address - Country:US
Mailing Address - Phone:423-863-0280
Mailing Address - Fax:
Practice Address - Street 1:609 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5403
Practice Address - Country:US
Practice Address - Phone:423-863-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health