Provider Demographics
NPI:1184879520
Name:MCCAIN, TANDRA LYN (BSW)
Entity type:Individual
Prefix:
First Name:TANDRA
Middle Name:LYN
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 PARK ASHWOOD CIRCLE
Mailing Address - Street 2:APT E
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304
Mailing Address - Country:US
Mailing Address - Phone:314-276-3605
Mailing Address - Fax:636-244-2755
Practice Address - Street 1:2722 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-1402
Practice Address - Country:US
Practice Address - Phone:314-276-3605
Practice Address - Fax:636-244-2755
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker