Active NPI
Maryellen Katherine Brunson McClain, PHD-LP
- Clinical Child & Adolescent Psychologist
- Logan, UT
National Provider Identifier
1346805066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- Practice address
- 6405 Old Main Hill
Logan, UT 84322-0001 - Phone
- (435) 797-1346
- Fax
- (844) 308-5865
- NPI assigned
- May 8, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | Primary |
Addresses
Primary practice location
6405 Old Main Hill
Logan, UT 84322-0001
Mailing address
6410 Old Main HL
Logan, UT 84322-6410
Phone (435) 797-1346
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10464447-2501 | Other | UT | LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | sue.reeder@usu.edu | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557273600000",
"number": "1346805066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6410 OLD MAIN HL",
"city": "LOGAN",
"state": "UT",
"postal_code": "843226410",
"telephone_number": "435-797-1346",
"fax_number": "844-308-5865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6405 OLD MAIN HILL",
"city": "LOGAN",
"state": "UT",
"postal_code": "843220001",
"telephone_number": "435-797-1346",
"fax_number": "844-308-5865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLAIN",
"first_name": "MARYELLEN",
"middle_name": "KATHERINE BRUNSON",
"credential": "PHD-LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-08",
"last_updated": "2019-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "10464447-2501",
"state": "UT"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "sue.reeder@usu.edu",
"affiliation": "N",
"endpointDescription": "credentialing",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "billing",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "billing office/credentialing",
"address_1": "6410 Old Main Hl",
"city": "Logan",
"state": "UT",
"country_code": "US",
"postal_code": "843226410",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Logan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.