Provider Demographics
NPI:1346072642
Name:MCCLAIN, BARBARA LEE (CADC1)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:LEE
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:CADC1
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:LEE
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:101YAO4OOX
Mailing Address - Street 1:6030 SE 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6117
Mailing Address - Country:US
Mailing Address - Phone:541-604-6251
Mailing Address - Fax:
Practice Address - Street 1:324 NW DAVIS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3925
Practice Address - Country:US
Practice Address - Phone:503-226-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18-07-19101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty