Provider Demographics
NPI:1063813608
Name:MCCOY, JORDAN (LMHP)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1686
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-1686
Mailing Address - Country:US
Mailing Address - Phone:308-224-0596
Mailing Address - Fax:308-237-5225
Practice Address - Street 1:15 W 22ND ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847
Practice Address - Country:US
Practice Address - Phone:308-224-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5129101YM0800X
NE10323101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health