Provider Demographics
NPI:1356611008
Name:MCLAIN, ALYSIA GAIL (LCSW)
Entity type:Individual
Prefix:MS
First Name:ALYSIA
Middle Name:GAIL
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALY
Other - Middle Name:
Other - Last Name:MCCLAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:875 FEATHER SKY ST NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-2767
Mailing Address - Country:US
Mailing Address - Phone:541-280-9613
Mailing Address - Fax:
Practice Address - Street 1:7515 FALCON CREST DR # 200
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-5014
Practice Address - Country:US
Practice Address - Phone:541-904-5216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8111820103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL8603OtherLCSW