Healthcare Provider Details

I. General information

NPI: 1104736016
Provider Name (Legal Business Name): RYAN MCCORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 S AUSTIN AVE
GEORGETOWN TX
78626-7541
US

IV. Provider business mailing address

2320 CAMINO DEL VERDES PL
ROUND ROCK TX
78681-2256
US

V. Phone/Fax

Practice location:
  • Phone: 512-819-1154
  • Fax:
Mailing address:
  • Phone: 512-903-4339
  • Fax: 512-903-4339

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:
Title or Position:
Credential:
Phone: