Provider Demographics
NPI:1821399874
Name:MCCORMICK, FLORENTINA ISABELLE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:FLORENTINA
Middle Name:ISABELLE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:FLORENTINA
Other - Middle Name:ISABELLE
Other - Last Name:ACOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4898 GOLDEN GATE AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-224-0031
Mailing Address - Fax:
Practice Address - Street 1:4898 GOLDEN GATE AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718
Practice Address - Country:US
Practice Address - Phone:406-224-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1523101YP2500X
MT1523-LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional