| Doctor Name: | MRS. KELLY TATE MCCLAIN |
| NPI Number: | 1033200340 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS |
| License Number: | |
| Business Practice Address: | Region Iii Mental Health Center 2434 South Eason Blvd Tupelo, MS - 388046942 |
| Business Phone Number: | 6628441717 |
| Business Fax Number: | 6626806416 |
| Mailing Address: | 611 Garfield Street, NEW ALBANY |
| State: | MS |
| Postal Code: | 38652 |
| Phone Number: | 6625380454 |
| Fax Number: | |
| NPI Enumeration Date: | 09/28/2006 |
| NPI Last Update Date: | 11/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |