Provider Demographics
NPI:1144399353
Name:MCCOY, KENNETH D (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:D
Last Name:MCCOY
Suffix:
Gender:M
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-4218
Mailing Address - Country:US
Mailing Address - Phone:765-529-3370
Mailing Address - Fax:765-529-7269
Practice Address - Street 1:321 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4218
Practice Address - Country:US
Practice Address - Phone:765-529-3370
Practice Address - Fax:765-529-7269
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040951A103G00000X, 103TA0700X, 103TB0200X, 103TC1900X, 103TF0000X, 103TM1800X, 103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11639000OtherMAGELLAN PROVIDER NO
IN000000180198OtherBCBS PROVIDER NO
IN11385019OtherCAQH PROVIDER NO
IN251319OtherVALUE OPTIONS PROVIDER NO
IN1297474OtherUNITED PROVIDER NO
IN251319OtherVALUE OPTIONS PROVIDER NO
NES041714Medicare UPIN