Provider Demographics
NPI:1275766180
Name:MCCAIN, CODY BLAKE (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:BLAKE
Last Name:MCCAIN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3718 WHITE RIVER
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-4814
Mailing Address - Country:US
Mailing Address - Phone:214-202-2264
Mailing Address - Fax:214-975-6981
Practice Address - Street 1:17480 DALLAS PKWY
Practice Address - Street 2:STE 114
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7303
Practice Address - Country:US
Practice Address - Phone:214-202-2264
Practice Address - Fax:214-975-6981
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health