Provider Demographics
NPI:1982721080
Name:MCLAIN, JOANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1234
Mailing Address - Street 2:34061 FOREST PARK DRIVE, SUITE 104
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-1234
Mailing Address - Country:US
Mailing Address - Phone:720-244-6329
Mailing Address - Fax:
Practice Address - Street 1:34061 FOREST PARK DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107
Practice Address - Country:US
Practice Address - Phone:720-244-6329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO65101YA0400X
CO1539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
11215058OtherCAQH