Provider Demographics
NPI:1043404197
Name:MCCOY, NANCY WOMACK (MA LPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:WOMACK
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S ACOMA BLVD
Mailing Address - Street 2:#204
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403
Mailing Address - Country:US
Mailing Address - Phone:928-680-6118
Mailing Address - Fax:928-680-6118
Practice Address - Street 1:30 S ACOMA BLVD
Practice Address - Street 2:#204
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403
Practice Address - Country:US
Practice Address - Phone:928-680-6118
Practice Address - Fax:928-680-6118
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ LPC 0240106H00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist