Healthcare Provider Details

I. General information

NPI: 1518818939
Provider Name (Legal Business Name): MCCORMACK & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 CAMPUS PLAZA CT STE 15
BOWLING GREEN KY
42101-7908
US

IV. Provider business mailing address

1733 CAMPUS PLAZA CT STE 15
BOWLING GREEN KY
42101-7908
US

V. Phone/Fax

Practice location:
  • Phone: 270-842-4991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HEIDI MCCORMACK
Title or Position: MANAGER
Credential: LCSW, CADC
Phone: 270-842-4991