Provider Demographics
NPI:1003680992
Name:MCCOY, MIRCHENY
Entity Type:Individual
Prefix:
First Name:MIRCHENY
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 SUMMER SAILS DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-8011
Mailing Address - Country:US
Mailing Address - Phone:813-464-0983
Mailing Address - Fax:813-252-1370
Practice Address - Street 1:339 SUMMER SAILS DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-8011
Practice Address - Country:US
Practice Address - Phone:813-464-0983
Practice Address - Fax:813-252-1370
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty