Provider Demographics
NPI:1710351549
Name:MCCORD, AMOS GENE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:AMOS
Middle Name:GENE
Last Name:MCCORD
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 STATE HIGHWAY 31 E
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8613
Mailing Address - Country:US
Mailing Address - Phone:903-596-8900
Mailing Address - Fax:903-596-8903
Practice Address - Street 1:2902 E. FRONT STREET
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8613
Practice Address - Country:US
Practice Address - Phone:903-596-8900
Practice Address - Fax:903-596-8903
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional