Provider Demographics
NPI:1093802019
Name:MCCOY, MARCIA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:LYNN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PHD
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 606
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-0606
Mailing Address - Country:US
Mailing Address - Phone:316-322-9500
Mailing Address - Fax:316-322-9500
Practice Address - Street 1:100 S. MAIN STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-0606
Practice Address - Country:US
Practice Address - Phone:316-322-9500
Practice Address - Fax:316-322-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS957103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4716OtherPREFERRED HEALTH SYSTEMS
KS118202OtherBCBS GROUP NUMBER
KS481246499 66502 A001OtherTRIWEST PROVIDER NUMBER
KS119741OtherBCBS INDIVIDUAL PROVIDER
KS4716OtherPREFERRED HEALTH SYSTEMS
KS119741OtherBCBS INDIVIDUAL PROVIDER