Basic Information
Provider Information
NPI: 1578801544
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCORD
FirstName: DEBORAH
MiddleName: LORRAINE
NamePrefix: MRS.
NameSuffix:  
Credential: B.A., BCABA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 21600 OXNARD ST
Address2: SUITE 1800
City: WOODLAND HILLS
State: CA
PostalCode: 913674976
CountryCode: US
TelephoneNumber: 8183452345
FaxNumber: 8184490994
Practice Location
Address1: 9901 NE 7TH AVE
Address2: SUITE C-116
City: VANCOUVER
State: WA
PostalCode: 986854523
CountryCode: US
TelephoneNumber: 3605712432
FaxNumber: 3608368131
Other Information
ProviderEnumerationDate: 01/24/2013
LastUpdateDate: 05/12/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000X0-10-3979FLY Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


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