Provider Demographics
NPI:1528511441
Name:MCCOY, KELLEE
Entity type:Individual
Prefix:
First Name:KELLEE
Middle Name:
Last Name:MCCOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 FINANCIAL CENTRE PKWY STE 290
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3581
Mailing Address - Country:US
Mailing Address - Phone:501-781-2230
Mailing Address - Fax:
Practice Address - Street 1:10800 FINANCIAL CENTRE PKWY STE 290
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3581
Practice Address - Country:US
Practice Address - Phone:501-781-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARF1606005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist