Individual
MIRANDA MCCOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5205 W FULTON ST, PHOENIX, AZ 85043-2000
(623) 204-8901
Mailing address
5205 W. FULTON, PHOENIX, AZ 85043
(623) 204-8901
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
11361
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115882
AHCCCS ID
AZ
Enumeration date
12/01/2006
Last updated
12/14/2007
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