Provider Demographics
NPI:1285272039
Name:MCCORD, BETH
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:MCCORD
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 1:436 HOUSTON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-2704
Mailing Address - Country:US
Mailing Address - Phone:606-584-1169
Mailing Address - Fax:
Practice Address - Street 1:5028 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYSLICK
Practice Address - State:KY
Practice Address - Zip Code:41055-8725
Practice Address - Country:US
Practice Address - Phone:160-637-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist