Healthcare Provider Details

I. General information

NPI: 1497093173
Provider Name (Legal Business Name): TERESA MARIE MCCANN M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N MONROE ST STE 200
SPOKANE WA
99201-2104
US

IV. Provider business mailing address

25870 LAKE FENWICK RD
KENT WA
98032-4276
US

V. Phone/Fax

Practice location:
  • Phone: 509-328-2740
  • Fax: 509-328-0773
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCL60203353
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: