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NPI Code Detail

MEDICARE: MR. MARC C MCCOY

MEDICARE: MR. MARC C MCCOY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1528115227
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARC C MCCOY
Provider Business Mailing Address
First Line : 8227 OUTLOOK AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94605-3540
Country : US
Telephone Number : 510-867-0969
Fax Number :
Provider Business Practice Location Address
First Line : 4368 LINCOLN AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94602-2529
Country : US
Telephone Number : 510-531-3111
Fax Number : 510-531-8498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2007
Last Update Date : 07/08/2007

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