Provider Demographics
NPI:1447606512
Name:MCCANN, MALLORY (LPC, NCC, BC-TMH)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:MCCANN
Suffix:
Gender:F
Credentials:LPC, NCC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 S JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2237
Mailing Address - Country:US
Mailing Address - Phone:972-391-4450
Mailing Address - Fax:
Practice Address - Street 1:7472 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-6611
Practice Address - Country:US
Practice Address - Phone:225-448-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6507101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6507OtherLPC LICENSE