Provider Demographics
NPI:1154768729
Name:MCCOY, JESSICA BUCKLEY (MMFT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BUCKLEY
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:BUCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 OAKDALE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2031
Mailing Address - Country:US
Mailing Address - Phone:161-544-4494
Mailing Address - Fax:
Practice Address - Street 1:207 OAKDALE DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2031
Practice Address - Country:US
Practice Address - Phone:161-544-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator