MEDICARE: MARY MCCOY CAS II

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACC0998571	CO

General Provider Information

NPI Number	:	1609450204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MCCOY CAS II

Provider Business Mailing Address
First Line	:	6825 E TENNESSEE AVE STE 109
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80224-1629
Country	:	US
Telephone Number	:	720-717-0499
Fax Number	:

Provider Business Practice Location Address
First Line	:	6825 E TENNESSEE AVE STE 109
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80224-1629
Country	:	US
Telephone Number	:	303-780-0170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	06/04/2024

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