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1154904373
JERRY TODD MCCOY
LAFAYETTE, IN
NPI
1154904373
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2021-05-05
Last Update Date
2021-05-05
Business Address
Mr. JERRY TODD MCCOY
4705 MEIJER CT
LAFAYETTE, IN 47905-4684
Phone number: 765-701-6060
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Mailing Address
Mr. JERRY TODD MCCOY
4705 MEIJER CT
LAFAYETTE, IN 47905-4684
Phone number: 765-701-6060
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