Provider Demographics
NPI:1902648090
Name:MCCLAIN, ANTHONY JAMAL
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JAMAL
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 GASTON RD APT 1808
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0854
Mailing Address - Country:US
Mailing Address - Phone:305-898-8538
Mailing Address - Fax:
Practice Address - Street 1:11600 GASTON RD APT 1808
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0854
Practice Address - Country:US
Practice Address - Phone:305-898-8538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician