Provider Demographics
NPI:1700996220
Name:MCCLAIN, TAMMY L (PSYD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-1035
Mailing Address - Country:US
Mailing Address - Phone:304-914-2436
Mailing Address - Fax:304-232-0719
Practice Address - Street 1:1025 MAIN ST
Practice Address - Street 2:SUITE 507
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2726
Practice Address - Country:US
Practice Address - Phone:304-233-4600
Practice Address - Fax:304-232-0719
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV854103TC0700X
OH5069103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000353399OtherANTHEM
OHP00164159OtherRAILROAD MEDICARE
OH2406480Medicaid
OH716953000OtherMAGELLAN
OHP00164159OtherRAILROAD MEDICARE