Provider Demographics
NPI:1386428563
Name:MCCANN, ALYSSAMARIE GWENDOLYN (MS, PPC)
Entity type:Individual
Prefix:MRS
First Name:ALYSSAMARIE
Middle Name:GWENDOLYN
Last Name:MCCANN
Suffix:
Gender:F
Credentials:MS, PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6943
Mailing Address - Country:US
Mailing Address - Phone:307-760-4165
Mailing Address - Fax:
Practice Address - Street 1:2617 E LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5660
Practice Address - Country:US
Practice Address - Phone:307-514-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1403101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor