Provider Demographics
NPI:1225196108
Name:MCCORMICK, JO ANN (MC)
Entity Type:Individual
Prefix:
First Name:JO ANN
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 E KELTON LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1109
Mailing Address - Country:US
Mailing Address - Phone:602-788-6287
Mailing Address - Fax:
Practice Address - Street 1:14045 N 7TH ST STE 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4387
Practice Address - Country:US
Practice Address - Phone:602-993-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-140101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional