Provider Demographics
NPI:1255913695
Name:MCCANE, TREVOR LARAY (BA)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:LARAY
Last Name:MCCANE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-3446
Mailing Address - Country:US
Mailing Address - Phone:580-286-6671
Mailing Address - Fax:
Practice Address - Street 1:1310 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-3446
Practice Address - Country:US
Practice Address - Phone:580-286-6671
Practice Address - Fax:580-286-5747
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator