Provider Demographics
NPI:1922144492
Name:MCCOY, TIMOTHY J (MA LSW LPC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MA LSW LPC
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 184
Mailing Address - Street 2:39 DEPOT ST SUITE ONE
Mailing Address - City:JANE LEW
Mailing Address - State:WV
Mailing Address - Zip Code:26378
Mailing Address - Country:US
Mailing Address - Phone:304-884-8878
Mailing Address - Fax:304-884-8878
Practice Address - Street 1:39 DEPOT ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:JANE LEW
Practice Address - State:WV
Practice Address - Zip Code:26378
Practice Address - Country:US
Practice Address - Phone:304-884-8878
Practice Address - Fax:304-884-8878
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist