Individual
MATTHEW MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDP
Contact information
Practice address
1044 11TH AVE, LONGVIEW, WA 98632-2506
(360) 397-8228
(360) 200-6736
Mailing address
PO BOX 2394, LONGVIEW, WA 98632
(360) 200-5419
(360) 200-6736
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60796310
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2121804
—
WA
Enumeration date
05/28/2015
Last updated
10/30/2020
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