Healthcare Provider Details

I. General information

NPI: 1124992342
Provider Name (Legal Business Name): BETHANY MARIE MCCLAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 BLACKJACK RD
MOUNT VERNON OH
43050-9193
US

IV. Provider business mailing address

865 ROYAL CIR
HOWARD OH
43028-9370
US

V. Phone/Fax

Practice location:
  • Phone: 740-963-3590
  • Fax:
Mailing address:
  • Phone: 740-507-6023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2613879
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: