MEDICARE: DR. SHANNON LYN MCLAIN PHD

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1376312249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON LYN MCLAIN PHD

Provider Business Mailing Address
First Line	:	4900 SHATTUCK AVE UNIT 3499
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-7018
Country	:	US
Telephone Number	:	415-704-9610
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 HEIGHTS DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89503-3825
Country	:	US
Telephone Number	:	262-470-8944
Fax Number	:

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

Provider Enumeration Date	:	12/20/2023
Last Update Date	:	12/20/2023

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