Healthcare Provider Details

I. General information

NPI: 1376312249
Provider Name (Legal Business Name): SHANNON LYN MCLAIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 HEIGHTS DR
RENO NV
89503-3825
US

IV. Provider business mailing address

4900 SHATTUCK AVE UNIT 3499
OAKLAND CA
94609-7018
US

V. Phone/Fax

Practice location:
  • Phone: 262-470-8944
  • Fax:
Mailing address:
  • Phone: 415-704-9610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: