Provider Demographics
NPI:1952616476
Name:MCLAIN, ANGELA MARIA (MA, PLPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIA
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2707 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7213
Mailing Address - Country:US
Mailing Address - Phone:870-972-4939
Mailing Address - Fax:870-972-4911
Practice Address - Street 1:602 DAVID ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-7268
Practice Address - Country:US
Practice Address - Phone:870-857-3655
Practice Address - Fax:870-857-3667
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012009480101YP2500X
AR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR226974719Medicaid