Provider Demographics
NPI:1982962106
Name:MCCOY, KERRY (LMFT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 CANYON CREST DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6015
Mailing Address - Country:US
Mailing Address - Phone:951-233-6923
Mailing Address - Fax:
Practice Address - Street 1:5053 LA MART DR
Practice Address - Street 2:SUITE 105
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0609
Practice Address - Country:US
Practice Address - Phone:951-233-6923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68253106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist