Provider Demographics
NPI:1851826523
Name:MCCORMICK, CODY SCOTT (LPCC, BCBA)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:SCOTT
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:LPCC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 NORTHERN SKY DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-8534
Mailing Address - Country:US
Mailing Address - Phone:701-751-6336
Mailing Address - Fax:701-751-6337
Practice Address - Street 1:4530 NORTHERN SKY DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-8534
Practice Address - Country:US
Practice Address - Phone:701-751-6336
Practice Address - Fax:701-751-6337
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03306101YP2500X
NDL108103K00000X
NE11110101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health