Healthcare Provider Details

I. General information

NPI: 1306758933
Provider Name (Legal Business Name): CODY JAMES MCCOOK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 SALVIO ST STE 301
CONCORD CA
94520-2143
US

IV. Provider business mailing address

5430 SANTA CRUZ AVE
RICHMOND CA
94804-5539
US

V. Phone/Fax

Practice location:
  • Phone: 925-692-0090
  • Fax:
Mailing address:
  • Phone: 310-482-7290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: