Provider Demographics
NPI:1497800635
Name:MCCOY, TIMOTHY C (QMHA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:MCCOY
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 SE 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-5212
Mailing Address - Country:US
Mailing Address - Phone:503-703-8683
Mailing Address - Fax:
Practice Address - Street 1:2034 SE DIVISION
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214
Practice Address - Country:US
Practice Address - Phone:503-238-6801
Practice Address - Fax:503-238-6810
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator