Provider Demographics
NPI:1518619451
Name:YORK, CODY DEWAYNE (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:DEWAYNE
Last Name:YORK
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 OAKLEY ALLONS RD
Mailing Address - Street 2:
Mailing Address - City:ALLONS
Mailing Address - State:TN
Mailing Address - Zip Code:38541-6921
Mailing Address - Country:US
Mailing Address - Phone:931-239-5608
Mailing Address - Fax:
Practice Address - Street 1:8 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3357
Practice Address - Country:US
Practice Address - Phone:931-330-0514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health