Provider Demographics
NPI:1609441708
Name:MCCANN, WARD KENT-WELLS
Entity Type:Individual
Prefix:
First Name:WARD
Middle Name:KENT-WELLS
Last Name:MCCANN
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:PO BOX 874686
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-4686
Mailing Address - Country:US
Mailing Address - Phone:850-737-0342
Mailing Address - Fax:
Practice Address - Street 1:3761 N HILLTOP DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623
Practice Address - Country:US
Practice Address - Phone:850-737-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health