Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 65708 | TX |
NPI | 1003250010 |
---|---|
Provider Name | Mrs. Kelley Mccoy |
First Address | Allen, TX 75002-4465 |
Second Address | Richardson, TX 75080-4657 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2013 |
Last Update Date | 20/04/2013 |