Healthcare Provider Details

I. General information

NPI: 1831029701
Provider Name (Legal Business Name): JEFFERY MCCOY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HUNTER DR
BENTON HARBOR MI
49022-6760
US

IV. Provider business mailing address

220 HUNTER DR
BENTON HARBOR MI
49022-6760
US

V. Phone/Fax

Practice location:
  • Phone: 269-338-6528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY MCCOY
Title or Position: OWNER
Credential: LCSW
Phone: 269-338-6528