Provider Demographics
NPI:1841833506
Name:MCLAIN, HOLLY C (LCSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:C
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:C
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:BANCROFT
Mailing Address - State:ID
Mailing Address - Zip Code:83217
Mailing Address - Country:US
Mailing Address - Phone:208-829-3160
Mailing Address - Fax:
Practice Address - Street 1:427 N MAIN
Practice Address - Street 2:STE 103
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3016
Practice Address - Country:US
Practice Address - Phone:208-829-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-419361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical