Provider Demographics
NPI:1336494459
Name:MCCAIN, JUSTIN DARRELL
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DARRELL
Last Name:MCCAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 KIOWA
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-5575
Mailing Address - Country:US
Mailing Address - Phone:405-397-4365
Mailing Address - Fax:
Practice Address - Street 1:27 KIOWA
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-5575
Practice Address - Country:US
Practice Address - Phone:405-397-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-14
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst