Provider Demographics
NPI:1770759284
Name:MCCOY, MICHAEL S (LMSW, CADC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:MCCOY
Suffix:
Gender:M
Credentials:LMSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 W FRANKLIN RD
Mailing Address - Street 2:STE 101
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1079
Mailing Address - Country:US
Mailing Address - Phone:208-336-9076
Mailing Address - Fax:208-336-9079
Practice Address - Street 1:5440 W FRANKLIN RD
Practice Address - Street 2:STE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1079
Practice Address - Country:US
Practice Address - Phone:208-336-9076
Practice Address - Fax:208-336-9079
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW 26787, CADC 107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health