Provider Demographics
NPI:1689177289
Name:MCCAIN, HENRY III (PHD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:MCCAIN
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 OCEAN PARK BLVD STE 1055
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5231
Mailing Address - Country:US
Mailing Address - Phone:269-224-1113
Mailing Address - Fax:
Practice Address - Street 1:2716 OCEAN PARK BLVD STE 1055
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5231
Practice Address - Country:US
Practice Address - Phone:269-224-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-10
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional