Provider Demographics
NPI:1457993198
Name:MCCONNELL, CODY (MS)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 COAL ST
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7843
Mailing Address - Country:US
Mailing Address - Phone:814-673-1378
Mailing Address - Fax:
Practice Address - Street 1:220 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-0806
Practice Address - Country:US
Practice Address - Phone:724-283-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional