Provider Demographics
NPI:1508366212
Name:MCCOY, MARIA T (LMFT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S FAIR OAKS AVE STE 227
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2083
Mailing Address - Country:US
Mailing Address - Phone:818-305-5569
Mailing Address - Fax:
Practice Address - Street 1:107 S FAIR OAKS AVE STE 227
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2083
Practice Address - Country:US
Practice Address - Phone:818-305-5569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102860101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health