Provider Demographics
NPI:1932381985
Name:MCCORMICK, TONY
Entity Type:Individual
Prefix:MS
First Name:TONY
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANTOINETTE
Other - Middle Name:MARIE
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6169 BEAL PL NW
Mailing Address - Street 2:
Mailing Address - City:SEABECK
Mailing Address - State:WA
Mailing Address - Zip Code:98380-8729
Mailing Address - Country:US
Mailing Address - Phone:206-799-2488
Mailing Address - Fax:
Practice Address - Street 1:6169 BEAL PL NW
Practice Address - Street 2:
Practice Address - City:SEABECK
Practice Address - State:WA
Practice Address - Zip Code:98380-8729
Practice Address - Country:US
Practice Address - Phone:206-799-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-02
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005402101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health