Healthcare Provider Details

I. General information

NPI: 1144399353
Provider Name (Legal Business Name): KENNETH D MCCOY PHD, HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 S MAIN ST
NEW CASTLE IN
47362-4218
US

IV. Provider business mailing address

321 S MAIN ST
NEW CASTLE IN
47362-4218
US

V. Phone/Fax

Practice location:
  • Phone: 765-529-3370
  • Fax: 765-529-7269
Mailing address:
  • Phone: 765-529-3370
  • Fax: 765-529-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number20040951A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number20040951A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number20040951A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20040951A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number20040951A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number20040951A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20040951A
License Number StateIN
# 8
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number20040951A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: