Provider Demographics
NPI:1629560305
Name:MCCOY, GARY (LPC3362)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:MCCOY
Suffix:
Gender:M
Credentials:LPC3362
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 GLADIOLA ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1517
Mailing Address - Country:US
Mailing Address - Phone:303-885-3703
Mailing Address - Fax:303-278-2369
Practice Address - Street 1:5245 GLADIOLA ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1517
Practice Address - Country:US
Practice Address - Phone:303-885-3703
Practice Address - Fax:303-278-2369
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCAC6163101YA0400X
COLPC3362101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty