Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 1307 | MS |
Y | 101YP2500X | Professional Counselor | 1586 | LA |
NPI | 1003121955 |
---|---|
Provider Name | Blythe B Mccance |
First Address | Metairie, LA 70002-1865 |
Second Address | Metairie, LA 70002-1865 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2010 |
Last Update Date | 16/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1307 | LPC (01) | MS |
1586 | LPC (01) | LA |