Provider Demographics
NPI:1720568645
Name:MCCOY-SHEPHERD, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MCCOY-SHEPHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12490 QUIVIRA RD APT 3524
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2458
Mailing Address - Country:US
Mailing Address - Phone:913-207-9866
Mailing Address - Fax:
Practice Address - Street 1:6828 LACKMAN RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9595
Practice Address - Country:US
Practice Address - Phone:913-608-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator