MEDICARE: CHANEL MCCORD MA, LPC

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	101YM0800X	Mental Health Counselor	37AC00182200	NJ
2	101YP2500X	Professional Counselor	37PC00598300	NJ

General Provider Information

NPI Number	:	1659709970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANEL MCCORD MA, LPC

Provider Business Mailing Address
First Line	:	770 WOODLANE RD
Second Line	:
City	:	MT. HOLLY
State	:	NJ
Zip	:	08060
Country	:	US
Telephone Number	:	609-267-5928
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 STATION AVE
Second Line	:
City	:	HADDON HEIGHTS
State	:	NJ
Zip	:	08035-1907
Country	:	US
Telephone Number	:	609-534-0219
Fax Number	:

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

Provider Enumeration Date	:	10/23/2013
Last Update Date	:	03/17/2018

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