Provider Demographics
NPI:1033244231
Name:ANDRUS MCCANN, ALLIE M (MFT, ATR-BC)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:M
Last Name:ANDRUS MCCANN
Suffix:
Gender:F
Credentials:MFT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 COBURN RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05667-4407
Mailing Address - Country:US
Mailing Address - Phone:650-283-0375
Mailing Address - Fax:
Practice Address - Street 1:435 PETALUMA AVE
Practice Address - Street 2:#140
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472
Practice Address - Country:US
Practice Address - Phone:707-219-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAMFC44433106H00000X
VT100.0134023106H00000X
CAMFT44433106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist