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General NPI Number Information
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NPI Number | 1699021766
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Entity Type | Individual
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Provider Name | MS. JAZMINE MCCOY
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Gender | Female
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 8775 SIERRA COLLEGE BLVD STE 250
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City | ROSEVILLE
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State | CA
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Zip | 95661-5986
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Country | US
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Telephone | 916-772-1642
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 340621
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City | SACRAMENTO
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State | CA
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Zip | 95834-0621
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Country | US
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Telephone | 916-772-1642
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 28892
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License Number State | CA
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