MEDICARE: MR. JOHN MARK MCCLANAHAN

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	99130944A	IN

General Provider Information

NPI Number	:	1487536587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MARK MCCLANAHAN

Provider Business Mailing Address
First Line	:	116 WINDING BROOK WAY
Second Line	:
City	:	PENDLETON
State	:	IN
Zip	:	46064-5514
Country	:	US
Telephone Number	:	317-200-7994
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 N STATE ROAD 1
Second Line	:
City	:	CAMBRIDGE CITY
State	:	IN
Zip	:	47327-9436
Country	:	US
Telephone Number	:	765-478-5395
Fax Number	:

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

Provider Enumeration Date	:	07/22/2025
Last Update Date	:	07/22/2025

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Directions to “ MR. JOHN MARK MCCLANAHAN ” Practice Location

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