Individual provider Active NPI

Bethel J McCoy, LISAC

  • Addiction (Substance Use Disorder) Counselor
  • Phoenix, AZ
National Provider Identifier
1194289124
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
LISAC-15083 Issued in AZ
Practice address
4909 E McDowell Rd
Phoenix, AZ 85008-4227
Phone
(602) 685-6000
Fax
(602) 275-1355
NPI assigned
Jan 23, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X LISAC-15083 AZ Primary

Addresses

Primary practice location

4909 E McDowell Rd
Phoenix, AZ 85008-4227

Mailing address

3003 N Central Ave Ste 400
Phoenix, AZ 85012-2929
Phone (026) 685-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LISAC-15083AZMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1194289124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 N CENTRAL AVE STE 400",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122929",
            "telephone_number": "026-685-6000",
            "fax_number": "026-302-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4909 E MCDOWELL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850084227",
            "telephone_number": "602-685-6000",
            "fax_number": "602-275-1355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOY",
        "first_name": "BETHEL",
        "middle_name": "J",
        "credential": "LISAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-23",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LISAC-15083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.