Provider Demographics
NPI:1063698892
Name:MCCLAIN, MINNIE
Entity type:Individual
Prefix:MS
First Name:MINNIE
Middle Name:
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 1:921 E COMPTON BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3303
Mailing Address - Country:US
Mailing Address - Phone:310-668-6929
Mailing Address - Fax:
Practice Address - Street 1:921 E COMPTON BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3303
Practice Address - Country:US
Practice Address - Phone:310-668-6929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool