Provider Demographics
NPI:1104160530
Name:MCCOOL, LINDSEY-KATE
Entity type:Individual
Prefix:MRS
First Name:LINDSEY-KATE
Middle Name:
Last Name:MCCOOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SAINT JOHNS STREET
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922
Mailing Address - Country:US
Mailing Address - Phone:321-639-9800
Mailing Address - Fax:
Practice Address - Street 1:550 SAINT JOHNS STREET
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922
Practice Address - Country:US
Practice Address - Phone:321-639-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL59-3454773103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst