Provider Demographics
NPI:1215125562
Name:LEN D MCCOY PSY D
Entity type:Organization
Organization Name:LEN D MCCOY PSY D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:509-338-9100
Mailing Address - Street 1:1260 SE BISHOP BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5451
Mailing Address - Country:US
Mailing Address - Phone:509-338-9100
Mailing Address - Fax:509-338-0905
Practice Address - Street 1:1260 SE BISHOP BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5451
Practice Address - Country:US
Practice Address - Phone:509-338-9100
Practice Address - Fax:509-338-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002727103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8801104Medicare PIN