Provider Demographics
NPI:1447497920
Name:MACLIN, JOHN THOMAS JR (LICENSED ALCOHOL DRU)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:MACLIN
Suffix:JR
Gender:M
Credentials:LICENSED ALCOHOL DRU
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8500 EDINBROOK PARKWAY #A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443
Mailing Address - Country:US
Mailing Address - Phone:612-462-0826
Mailing Address - Fax:763-777-5685
Practice Address - Street 1:8500 EDINBROOK PARKWAY #A
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443
Practice Address - Country:US
Practice Address - Phone:612-462-0826
Practice Address - Fax:763-777-5685
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN301427101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)