MEDICARE: DR. STACY LYNN 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	103T00000X	Psychologist	PSY17699	CA

General Provider Information

NPI Number	:	1982835781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY LYNN MCLAIN PHD

Provider Business Mailing Address
First Line	:	4195 CHINO HILLS PKWY
Second Line	:	#350
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-2618
Country	:	US
Telephone Number	:	909-641-4731
Fax Number	:	951-340-2872

Provider Business Practice Location Address
First Line	:	4195 CHINO HILLS PKWY
Second Line	:	#350
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-2618
Country	:	US
Telephone Number	:	909-641-4731
Fax Number	:	951-340-2872

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

Provider Enumeration Date	:	07/28/2009
Last Update Date	:	07/28/2009

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