Provider Demographics
NPI:1134870934
Name:MCCOY, KATHLEEN ELIZABETH (MA, CRC, LPC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MA, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 HARKE LN
Mailing Address - Street 2:
Mailing Address - City:OLD MONROE
Mailing Address - State:MO
Mailing Address - Zip Code:63369
Mailing Address - Country:US
Mailing Address - Phone:636-443-5137
Mailing Address - Fax:
Practice Address - Street 1:79 HARKE LN
Practice Address - Street 2:
Practice Address - City:OLD MONROE
Practice Address - State:MO
Practice Address - Zip Code:63369
Practice Address - Country:US
Practice Address - Phone:636-443-5137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021050866101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor