MEDICARE: DIAMOND MCCLAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor	39005666A	IN

General Provider Information

NPI Number	:	1376241935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIAMOND MCCLAM

Provider Business Mailing Address
First Line	:	3729 BEARWOOD DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-3537
Country	:	US
Telephone Number	:	219-682-7123
Fax Number	:

Provider Business Practice Location Address
First Line	:	3729 BEARWOOD DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-3537
Country	:	US
Telephone Number	:	219-682-7123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2023
Last Update Date	:	01/21/2026

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Directions to “ DIAMOND MCCLAM ” Practice Location

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