Healthcare Provider Details

I. General information

NPI: 1336201029
Provider Name (Legal Business Name): LEN D MCCOY PSY D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 SE BISHOP BLVD SUITE B
PULLMAN WA
99163-5451
US

IV. Provider business mailing address

1260 SE BISHOP BLVD SUITE B
PULLMAN WA
99163-5451
US

V. Phone/Fax

Practice location:
  • Phone: 509-338-9100
  • Fax: 509-338-0905
Mailing address:
  • Phone: 509-338-9100
  • Fax: 509-338-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00002727
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00002727
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: