Provider Demographics
NPI:1003644964
Name:MCCOY, KAILA LYNN RASHON
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:LYNN RASHON
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 S VINE ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-4228
Mailing Address - Country:US
Mailing Address - Phone:765-730-7318
Mailing Address - Fax:
Practice Address - Street 1:2200 S VINE ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-4228
Practice Address - Country:US
Practice Address - Phone:765-730-7318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health