| Doctor Name: | MS. CONNIE JANE MCCLAIN |
| NPI Number: | 1861724577 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BSW |
| License Number: | |
| Business Practice Address: | 2 Wickersham St Mangum, OK - 735549117 |
| Business Phone Number: | 5807823337 |
| Business Fax Number: | |
| Mailing Address: | Po Box 364, CARTER |
| State: | OK |
| Postal Code: | 736270364 |
| Phone Number: | 4058344527 |
| Fax Number: | |
| NPI Enumeration Date: | 02/04/2010 |
| NPI Last Update Date: | 02/04/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |