Provider Demographics
NPI:1336201029
Name:MCCOY, LEN D (PSY D)
Entity Type:Individual
Prefix:
First Name:LEN
Middle Name:D
Last Name:MCCOY
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 SE BISHOP BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5451
Mailing Address - Country:US
Mailing Address - Phone:509-338-9100
Mailing Address - Fax:509-338-0905
Practice Address - Street 1:1260 SE BISHOP BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5451
Practice Address - Country:US
Practice Address - Phone:509-338-9100
Practice Address - Fax:509-338-0905
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002727103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8801106Medicare PIN