Provider Demographics
NPI:1821221151
Name:MCCOY, ROSS EUGENE (MSW)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:EUGENE
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21825 155TH STREET
Mailing Address - Street 2:
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007
Mailing Address - Country:US
Mailing Address - Phone:913-416-0522
Mailing Address - Fax:913-724-4900
Practice Address - Street 1:21825 155TH STREET
Practice Address - Street 2:
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007
Practice Address - Country:US
Practice Address - Phone:913-416-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7545104100000X
KS7601104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker