Basic Information
| Provider Information | |||||||||
| NPI: | 1760830764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCANN | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | BOUDREAUX | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MS, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 S PENN AVE | ||||||||
| Address2: | |||||||||
| City: | BARTLESVILLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740033847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183378080 | ||||||||
| FaxNumber: | 9183378099 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 S PENN AVE | ||||||||
| Address2: | |||||||||
| City: | BARTLESVILLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740033847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183378080 | ||||||||
| FaxNumber: | 9183378099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2016 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.