Healthcare Provider Details

I. General information

NPI: 1851826523
Provider Name (Legal Business Name): CODY SCOTT MCCORMICK BCBA, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 NORTHERN SKY DR
BISMARCK ND
58503-8534
US

IV. Provider business mailing address

4530 NORTHERN SKY DR
BISMARCK ND
58503-8534
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-6336
  • Fax: 701-751-6337
Mailing address:
  • Phone: 701-751-6336
  • Fax: 701-751-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL108
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0463
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11110
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC03306
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: