Healthcare Provider Details

I. General information

NPI: 1710270566
Provider Name (Legal Business Name): KEITH LAFAYETTE MCCANN II M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 E 22ND ST N BLDG 800
WICHITA KS
67226-2350
US

IV. Provider business mailing address

2325 S HARVARD AVE STE 400
TULSA OK
74114-3304
US

V. Phone/Fax

Practice location:
  • Phone: 316-201-6047
  • Fax: 316-330-3980
Mailing address:
  • Phone: 918-712-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: