Provider Demographics
NPI:1669879102
Name:MCCANN, CHRIS ANN (MS, LAC, LCPC)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:ANN
Last Name:MCCANN
Suffix:
Gender:F
Credentials:MS, LAC, LCPC
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 134
Mailing Address - Street 2:
Mailing Address - City:ABSAROKEE
Mailing Address - State:MT
Mailing Address - Zip Code:59001-0134
Mailing Address - Country:US
Mailing Address - Phone:406-780-0528
Mailing Address - Fax:
Practice Address - Street 1:612 E PIKE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019
Practice Address - Country:US
Practice Address - Phone:406-780-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-27
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLAC-LAC-LIC-4177101YA0400X
MTBBH-LCPC-LIC-29952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1669879102Medicaid