Provider Demographics
NPI:1003121955
Name:MCCANCE, BLYTHE B (LPC)
Entity type:Individual
Prefix:
First Name:BLYTHE
Middle Name:B
Last Name:MCCANCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 5TH ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-1865
Mailing Address - Country:US
Mailing Address - Phone:504-491-4269
Mailing Address - Fax:504-302-9186
Practice Address - Street 1:3001 5TH ST
Practice Address - Street 2:STE. 201
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-1865
Practice Address - Country:US
Practice Address - Phone:504-491-4269
Practice Address - Fax:504-302-9186
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1586101YP2500X
MS1307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1586OtherLPC
MS1307OtherLPC