Healthcare Provider Details

I. General information

NPI: 1225152002
Provider Name (Legal Business Name): MELISSA KRISTINE MCLAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA KRISTINE HOBBS

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 HIGHWAY 51 S
HERNANDO MS
38632-2634
US

IV. Provider business mailing address

815 N 8TH AVE
CANTON IL
61520-1430
US

V. Phone/Fax

Practice location:
  • Phone: 662-449-1971
  • Fax: 662-449-1974
Mailing address:
  • Phone: 309-344-4236
  • Fax: 309-344-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2977
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: