Provider Demographics
NPI:1699130195
Name:MCCOY, ROBIN ELAINE (PHD, LLP)
Entity type:Individual
Prefix:MISS
First Name:ROBIN
Middle Name:ELAINE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PHD, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25595 MULROY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2510
Mailing Address - Country:US
Mailing Address - Phone:602-791-1684
Mailing Address - Fax:
Practice Address - Street 1:17515 W 9 MILE RD STE 240
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4423
Practice Address - Country:US
Practice Address - Phone:248-579-2188
Practice Address - Fax:248-715-5903
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016485103T00000X, 103TC0700X
MI6361007845103TA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1699130195.Medicaid
MIENUMERATION DATE:Medicaid