Provider Demographics
NPI:1548643141
Name:JO LYNN MCCLAIN, PSY.D.
Entity type:Organization
Organization Name:JO LYNN MCCLAIN, PSY.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JO
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:276-632-3572
Mailing Address - Street 1:1079 SPRUCE ST
Mailing Address - Street 2:STE A
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-4527
Mailing Address - Country:US
Mailing Address - Phone:276-632-3572
Mailing Address - Fax:276-638-5287
Practice Address - Street 1:1079 SPRUCE ST
Practice Address - Street 2:STE A
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4527
Practice Address - Country:US
Practice Address - Phone:276-632-3572
Practice Address - Fax:276-638-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000335103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190002166OtherMEDICARE PTAN