Provider Demographics
NPI:1043382542
Name:MCCOY, KELVIN DREW (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:DREW
Last Name:MCCOY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 N ALLEN DR STE 204
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2568
Mailing Address - Country:US
Mailing Address - Phone:972-233-1010
Mailing Address - Fax:214-623-6692
Practice Address - Street 1:100 ALLENTOWN PKWY STE 206
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-4215
Practice Address - Country:US
Practice Address - Phone:972-233-1010
Practice Address - Fax:214-623-6692
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX378801041C0700X
IL149.0082201041C0700X
TX623481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1558496-02Medicaid
TX1558496-02Medicaid