Provider Demographics
NPI:1659076156
Name:MCCORD, DAVID LEWIS (AMFT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEWIS
Last Name:MCCORD
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PLAZA STE B
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-2554
Mailing Address - Country:US
Mailing Address - Phone:209-585-3509
Mailing Address - Fax:
Practice Address - Street 1:969 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3330
Practice Address - Country:US
Practice Address - Phone:209-606-3053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC13828101YP2500X
CAAMFT138719106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional