Provider Demographics
NPI:1194226985
Name:MCCOY, BRIANNA LASHEA
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LASHEA
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N. MARTIN LUTHER KING BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032
Mailing Address - Country:US
Mailing Address - Phone:702-684-7757
Mailing Address - Fax:702-684-7381
Practice Address - Street 1:3925 N. MARTIN LUTHER KING BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-684-7757
Practice Address - Fax:702-684-7381
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health