Othea McCoy Mance

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

31512 Issued in TX

Practice address

4411 Dacoma St
Houston, TX 77092-8611

Phone

(713) 686-9194

Fax

(713) 686-9413

NPI assigned

Nov 6, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Othea McCoy Mance Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1572998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1184268773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 FEU FOLLET RD STE 100",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705084234",
            "telephone_number": "713-686-9194",
            "fax_number": "713-686-9413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 DACOMA ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770928611",
            "telephone_number": "713-686-9194",
            "fax_number": "713-686-9413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOY MANCE",
        "first_name": "OTHEA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-06",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "31512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "408994801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OTHEA",
            "last_name": "MCCOY MANCE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Frank Brandt McCormick Jr.
• Hannah Nicole McCorry
• Christine Elizabeth McCorvey, PA
• Christopher James McCowan
• James Edward McCowan Jr.
• Andrea Lynn McCoy, NP
• Aubrey Lamar McCoy
• Brian McCoy, PTA
• Callie McCoy
• Deborah D McCoy, MD

• Clinical Social Worker in Houston, TX
• Providers in Houston, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.