MEDICARE: JEFFERY 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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1831029701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERY MCCOY

Provider Business Mailing Address
First Line	:	220 HUNTER DR
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-6760
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 HUNTER DR
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-6760
Country	:	US
Telephone Number	:	269-338-6528
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFERY MCCOY
Credential	:	LCSW
Telephone Number	:	269-338-6528

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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