Provider Demographics
NPI:1609665272
Name:MCCANN, TIMOTHY W (BHP, MSL, LIAC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:W
Last Name:MCCANN
Suffix:
Gender:
Credentials:BHP, MSL, LIAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 W ROAN PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-8243
Mailing Address - Country:US
Mailing Address - Phone:602-476-4458
Mailing Address - Fax:
Practice Address - Street 1:1275 W STARR PASS BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-1379
Practice Address - Country:US
Practice Address - Phone:602-476-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ155274101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)