Provider Demographics
NPI:1225327877
Name:MCCANN, DAVID RUSSELL (PHD; RP)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUSSELL
Last Name:MCCANN
Suffix:
Gender:M
Credentials:PHD; RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 E. MATILIJA ST. # 110-158
Mailing Address - Street 2:2125 MCNELL ROAD
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023
Mailing Address - Country:US
Mailing Address - Phone:805-646-4455
Mailing Address - Fax:805-646-4455
Practice Address - Street 1:323 E. MATILIJA ST. # 110-158
Practice Address - Street 2:2125 MCNELL ROAD
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023
Practice Address - Country:US
Practice Address - Phone:805-646-4455
Practice Address - Fax:805-646-4455
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARP018102L00000X
RP018106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZ11442ZOtherBLUE SHIELD, CALIF