Provider Demographics
NPI:1649395419
Name:MCCOY, MICHELLE RENEE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENEE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:RENEE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:1300 E SHAW AVE STE 172
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7911
Mailing Address - Country:US
Mailing Address - Phone:559-554-9710
Mailing Address - Fax:559-554-9711
Practice Address - Street 1:1300 E SHAW AVE STE 172
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-484-2021
Practice Address - Fax:559-554-9711
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49307101YM0800X
CA80212106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851756092Medicaid