1275766180 NPI number — MR. CODY BLAKE MCCAIN M.A., LPC

Table of content: MR. CODY BLAKE MCCAIN M.A., LPC (NPI 1275766180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275766180 NPI number — MR. CODY BLAKE MCCAIN M.A., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCAIN
Provider First Name:
CODY
Provider Middle Name:
BLAKE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275766180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3718 WHITE RIVER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75287-4814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-202-2264
Provider Business Mailing Address Fax Number:
214-975-6981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17480 DALLAS PKWY
Provider Second Line Business Practice Location Address:
STE 114
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75287-7303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-202-2264
Provider Business Practice Location Address Fax Number:
214-975-6981
Provider Enumeration Date:
08/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  63367 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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