Provider Demographics
NPI:1578529095
Name:SANDRA J. MCCOY, PH.D., P.A.
Entity Type:Organization
Organization Name:SANDRA J. MCCOY, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:785-539-9600
Mailing Address - Street 1:400 OSAGE ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5930
Mailing Address - Country:US
Mailing Address - Phone:785-539-9600
Mailing Address - Fax:785-537-6280
Practice Address - Street 1:400 OSAGE ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5930
Practice Address - Country:US
Practice Address - Phone:785-539-9600
Practice Address - Fax:785-537-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100429550BMedicaid