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General NPI Number Information
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NPI Number | 1558563759
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Entity Type | Individual
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Provider Name | VICKI DIANA MCCLAIN LPC
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Gender | Female
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3233 E MEMORIAL RD
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City | EDMOND
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State | OK
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Zip | 73013-7082
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Country | US
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Telephone | 405-603-3475
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Fax | 405-603-3475
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Provider Business Mailing Address
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Address Line | 10417 BLUE SPRUCE RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73162-6725
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Country | US
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Telephone | 405-627-2034
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Fax | 405-627-2034
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3214
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License Number State | OK
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