Healthcare Provider Details

I. General information

NPI: 1023531977
Provider Name (Legal Business Name): DAVID OWEN MCCORMICK LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 ORANGE MEADOW ST
LAS VEGAS NV
89142-0692
US

IV. Provider business mailing address

1281 ORANGE MEADOW ST
LAS VEGAS NV
89142-0692
US

V. Phone/Fax

Practice location:
  • Phone: 725-321-6011
  • Fax:
Mailing address:
  • Phone: 725-321-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP0298
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: