Individual
MELVIN MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
402 PEAKE ST, LAKE CHARLES, LA 70601-6048
(219) 852-9566
Mailing address
402 PEAKE ST, LAKE CHARLES, LA 70601-6048
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
863882825
—
PA
Enumeration date
06/21/2021
Last updated
06/21/2021
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