Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 20040951A | IN |
N | 103TC0700X | Clinical Psychologist | 20040951A | IN |
N | 102L00000X | Psychologist | 20040951A | IN |
N | 103T00000X | Psychologist | 20040951A | IN |
N | 103TA0700X | Adult Development & Aging Psychologist | 20040951A | IN |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 20040951A | IN |
N | 103TC1900X | Counseling Psychologist | 20040951A | IN |
N | 103TF0000X | Family Psychologist | 20040951A | IN |
N | 103TM1800X | Intellectual & Developmental Disabilities | 20040951A | IN |
N | 103TP2701X | Group Psychotherapist | 20040951A | IN |
NPI | 1144399353 |
---|---|
Provider Name | Dr. Kenneth D Mccoy |
First Address | New Castle, IN 47362-4218 |
Second Address | New Castle, IN 47362-4218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000180198 | BCBS PROVIDER NO (01) | IN |
11385019 | CAQH PROVIDER NO (01) | IN |
11639000 | MAGELLAN PROVIDER NO (01) | IN |
1297474 | UNITED PROVIDER NO (01) | IN |
251319 | VALUE OPTIONS PROVIDER NO (01) | IN |
S041714 | (02) | NE |