Provider Demographics
NPI:1699951517
Name:MCCANDLESS, DOREEN MARY (LMFT)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:MARY
Last Name:MCCANDLESS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44447 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3324
Mailing Address - Country:US
Mailing Address - Phone:661-726-2630
Mailing Address - Fax:661-940-3412
Practice Address - Street 1:44447 10TH ST. WEST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-726-2630
Practice Address - Fax:661-940-3412
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 54016106H00000X
CALMFT91281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT91281OtherCLINICAL SUPERVISOR