Provider Demographics
NPI:1134281462
Name:MCCOY, CLAUDE OLIVER (MD)
Entity type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:OLIVER
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18722 88TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-5712
Mailing Address - Country:US
Mailing Address - Phone:425-774-2961
Mailing Address - Fax:
Practice Address - Street 1:555 DAYTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3601
Practice Address - Country:US
Practice Address - Phone:425-774-4673
Practice Address - Fax:425-774-0690
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health