Provider Demographics
NPI:1669975348
Name:MCCLAIN, NICKOLAS (RBT)
Entity type:Individual
Prefix:MR
First Name:NICKOLAS
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 HILLEGAS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-1934
Mailing Address - Country:US
Mailing Address - Phone:260-338-1241
Mailing Address - Fax:260-338-1231
Practice Address - Street 1:4935 HILLEGAS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-1934
Practice Address - Country:US
Practice Address - Phone:260-338-1241
Practice Address - Fax:260-338-1231
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-17-41654106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician