Provider Demographics
NPI:1700122710
Name:MCKOY, TERRI RENEE (LPC, LCAS, CSI)
Entity Type:Individual
Prefix:MISS
First Name:TERRI
Middle Name:RENEE
Last Name:MCKOY
Suffix:
Gender:F
Credentials:LPC, LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14837 ASHTON RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2346
Mailing Address - Country:US
Mailing Address - Phone:252-673-6769
Mailing Address - Fax:
Practice Address - Street 1:1715 INDIAN WOOD CIRCLE
Practice Address - Street 2:SUITE 200
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:734-531-7314
Practice Address - Fax:734-629-0355
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2487-A101Y00000X
NC2487-A101YA0400X
NC12137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)