Provider Demographics
NPI:1922045244
Name:MCCORMICK, NAOMI BETH (PHD)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:BETH
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1066
Mailing Address - Street 2:CLINICAL HEALTH PSYCHOLOGISTS, PLC
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-0048
Mailing Address - Country:US
Mailing Address - Phone:319-240-7456
Mailing Address - Fax:
Practice Address - Street 1:2717 MINNETONKA DR
Practice Address - Street 2:CLINICAL HEALTH PSYCHOLOGISTS, PLC
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-1531
Practice Address - Country:US
Practice Address - Phone:319-240-7456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00809103TC0700X
IA000809103TH0004X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
142854OtherVALUE OPTIONS
IA174144000Medicaid
IA22718OtherBLUE CROSS BLUE SHIELD
IA22718OtherBLUE CROSS BLUE SHIELD
142854OtherVALUE OPTIONS