Provider Demographics
NPI:1386021889
Name:MCKOY, CASSANDRA (MS, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:
Last Name:MCKOY
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:MRS
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:MCKOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPCC
Mailing Address - Street 1:529 E STROOP RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3245
Mailing Address - Country:US
Mailing Address - Phone:937-294-6004
Mailing Address - Fax:937-294-9053
Practice Address - Street 1:529 EAST STROOP ROAD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-294-6004
Practice Address - Fax:937-294-9053
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health