Provider Demographics
NPI:1003250010
Name:MCCOY, KELLEY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 BRAZOS CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-4465
Mailing Address - Country:US
Mailing Address - Phone:214-733-9877
Mailing Address - Fax:
Practice Address - Street 1:1401 N CENTRAL EXPY STE 375
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4657
Practice Address - Country:US
Practice Address - Phone:214-733-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-20
Last Update Date:2013-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65708101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional