Provider Demographics
NPI:1497093173
Name:MCCANN, TERESA MARIE (MED)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:MCCANN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25870 LAKE FENWICK RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4276
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 N MONROE ST
Practice Address - Street 2:STE 200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2104
Practice Address - Country:US
Practice Address - Phone:509-328-2740
Practice Address - Fax:509-328-0773
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60203353101Y00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor