Provider Demographics
NPI:1104138148
Name:MCLAIN, MEGHAN K (PSYD)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:K
Last Name:MCLAIN
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 E BRIDGE ST STE C-2
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1350
Mailing Address - Country:US
Mailing Address - Phone:616-600-2845
Mailing Address - Fax:616-253-8927
Practice Address - Street 1:8 E BRIDGE ST STE C-2
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1350
Practice Address - Country:US
Practice Address - Phone:616-600-2845
Practice Address - Fax:616-253-8927
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OR2268103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301017171OtherLICENSE
R0000WDBCHOtherMEDICARE GROUP