Provider Demographics
NPI:1326544941
Name:MCCANN, MOLLY (BCBA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MCCANN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 APEX DR APT 101
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-5630
Mailing Address - Country:US
Mailing Address - Phone:630-947-9807
Mailing Address - Fax:
Practice Address - Street 1:4126 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4123
Practice Address - Country:US
Practice Address - Phone:812-645-2308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-18-29733103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst