Healthcare Provider Details

I. General information

NPI: 1619049210
Provider Name (Legal Business Name): JAMES ALEXANDER MCCOSH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N PECOS RD SUITE #110
HENDERSON NV
89074-7361
US

IV. Provider business mailing address

223 N PECOS RD SUITE #110
HENDERSON NV
89074-7361
US

V. Phone/Fax

Practice location:
  • Phone: 702-256-8900
  • Fax: 702-873-2710
Mailing address:
  • Phone: 702-256-8900
  • Fax: 702-873-2710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY279
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: