Provider Demographics
NPI:1043208861
Name:MCCOY, PM MARKIE (DCSW LSW LMFT BCD)
Entity Type:Individual
Prefix:MRS
First Name:PM
Middle Name:MARKIE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:DCSW LSW LMFT BCD
Other - Prefix:MRS
Other - First Name:PM
Other - Middle Name:MARKIE
Other - Last Name:BOBINET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:812 DRIPPING SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-8763
Mailing Address - Country:US
Mailing Address - Phone:405-348-3655
Mailing Address - Fax:405-348-7208
Practice Address - Street 1:3600 W SIMMONS RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8163
Practice Address - Country:US
Practice Address - Phone:405-348-3655
Practice Address - Fax:405-348-7208
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLCSW231103T00000X
OKLMFT110106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist