Provider Demographics
NPI:1649495920
Name:HADDOCK, MCCOY DEAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MCCOY
Middle Name:DEAN
Last Name:HADDOCK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 82096
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93380-2096
Mailing Address - Country:US
Mailing Address - Phone:661-326-8167
Mailing Address - Fax:661-326-8221
Practice Address - Street 1:4900 CALIFORNIA AVE
Practice Address - Street 2:SUITE 330B
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7024
Practice Address - Country:US
Practice Address - Phone:661-326-8167
Practice Address - Fax:661-326-8221
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8536103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY8536OtherCALIF LIC