Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 30569 | TX |
N | 103T00000X | Psychologist | 30569 | TX |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 30569 | TX |
NPI | 1073690608 |
---|---|
Provider Name | Victoria M Mccain |
First Address | Fort Worth, TX 76104-2733 |
Second Address | Fort Worth, TX 76104-2710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G981 | BCBSTX GRP PIN (01) | TX |
10013975 | AMERIGROUP PIN (01) | TX |
124163 | SUPERIOR PIN (01) | TX |
1336198894 | GRP NPI NUMBER (01) | |
165067301 | (05) | TX |
2241238 | FIRSTHEALTH PIN (01) | TX |
75205164617 | PBH PIN (01) | TX |
86922A | BCBSTX IND PIN (01) | TX |