Provider Demographics
NPI:1801676242
Name:MCCLAIN, ALLISON TEAL
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:TEAL
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CYPRESS CREEK RD APT 415
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4448
Mailing Address - Country:US
Mailing Address - Phone:512-985-7694
Mailing Address - Fax:
Practice Address - Street 1:350 CYPRESS CREEK RD APT 415
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4448
Practice Address - Country:US
Practice Address - Phone:512-985-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50161222172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50161222OtherTEXAS CERTIFICATION BOARD