Provider Demographics
NPI:1609643030
Name:MCCLANAHAN, KIM (MED, LPC, LPCC)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:MCCLANAHAN
Suffix:
Gender:F
Credentials:MED, LPC, LPCC
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:KIMBERLY
Other - Last Name:MCCLANAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LPC, LPCC
Mailing Address - Street 1:PO BOX 4013
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508
Mailing Address - Country:US
Mailing Address - Phone:304-855-1222
Mailing Address - Fax:304-310-2307
Practice Address - Street 1:594 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-855-1222
Practice Address - Fax:304-310-2307
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2980101YM0800X, 101YP2500X
KY291218101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health