Bruce K McCormick, PHD

Primary specialty

Prescribing (Medical) PsychologistTaxonomy code 103TP0016X

License

MPAP.000013 Issued in LA

Practice address

3341 Youree Dr Ste 20a
Shreveport, LA 71105-2149

Phone

(318) 865-7500

Fax

(318) 868-2035

NPI assigned

Aug 24, 2006

Last updated

Sep 19, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 8

Addresses

Other names 1

• B K McCormick PHD Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2017 through Apr 1, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Psychology and Counseling

  • Prescribing (Medical) Psychologist
  • Shreveport, LA
  • NPI 1730446410
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1043327968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3341 YOUREE DR STE 20A",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711052149",
            "telephone_number": "318-865-7500",
            "fax_number": "318-868-2035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3341 YOUREE DR STE 20A",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711052149",
            "telephone_number": "318-865-7500",
            "fax_number": "318-868-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "BRUCE",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "LA",
            "license": "631",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "LA",
            "license": "631",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "LA",
            "license": "631",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "LA",
            "license": "631",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "LA",
            "license": "631",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "LA",
            "license": "631",
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "LA",
            "license": "631MP",
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "LA",
            "license": "MPAP.000013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "B",
            "last_name": "MCCORMICK PHD",
            "middle_name": "K",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Faith McCollister
• Ashley M McCollough, P.T.
• Bradly Scott McCollum, LCSW
• Natalie McConnell, MD
• Stephanie McConnell, M.A.
• Carla McCormick
• Elizabeth McCormick, PHARMD
• Greta Anita McCormick, MSN, APRN, PMHNP-BC
• Ashley Nicole McCoy
• Barbara W McCoy, MIDWIFE, WHNP

• Prescribing (Medical) Psychologist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Prescribing (Medical) Psychologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.