Provider Demographics
NPI:1609450204
Name:MCCOY, MARY (CAS II)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:CAS II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 E TENNESSEE AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1629
Mailing Address - Country:US
Mailing Address - Phone:720-717-0499
Mailing Address - Fax:
Practice Address - Street 1:6825 E TENNESSEE AVE STE 109
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1629
Practice Address - Country:US
Practice Address - Phone:303-780-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC0998571101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)