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General NPI Number Information
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NPI Number | 1487079646
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Entity Type | Individual
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Provider Name | AUSTIN WADE MCCOY LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/25/2014
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 4933 E 25TH PL
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City | TULSA
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State | OK
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Zip | 74114-3727
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Country | US
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Telephone | 918-706-1468
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Fax |
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Provider Business Mailing Address
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Address Line | 19831 E ROCKY CT
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City | OWASSO
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State | OK
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Zip | 74055-0409
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Country | US
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Telephone | 918-706-1468
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6343
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License Number State | OK
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