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 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-264-6000
Mailing Address - Fax:601-545-1740
Practice Address - Street 1:102 MEDICAL PARK STE B
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-9080
Practice Address - Country:US
Practice Address - Phone:601-261-1650
Practice Address - Fax:601-545-1740
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2025-09-12
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