Healthcare Provider Details

I. General information

NPI: 1619049178
Provider Name (Legal Business Name): JOSLYN MASON MCCOY PH.D., BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 DEMANADE BLVD
LAFAYETTE LA
70503
US

IV. Provider business mailing address

4400A AMBASSADOR CAFFERY PKWY # 300
LAFAYETTE LA
70508-6706
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-8679
  • Fax: 337-534-0027
Mailing address:
  • Phone: 337-962-1785
  • Fax: 337-385-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1019
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-022
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: