Provider Demographics
NPI:1972357846
Name:MUNDY-MCCOOK, ERIN (MA)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:MUNDY-MCCOOK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:MUNDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 ELK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-3434
Mailing Address - Country:US
Mailing Address - Phone:209-745-5470
Mailing Address - Fax:
Practice Address - Street 1:1000 ELK HILLS DR
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-3434
Practice Address - Country:US
Practice Address - Phone:209-745-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60080103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool