Basic Information
| Provider Information | |||||||||
| NPI: | 1962709931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COY | ||||||||
| FirstName: | BARRY | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.ED., LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3089 | ||||||||
| Address2: | CENTER FOR MENTAL HEALTH | ||||||||
| City: | GREAT FALLS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 594033089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062659639 | ||||||||
| FaxNumber: | 4062656771 | ||||||||
| Practice Location | |||||||||
| Address1: | 312 3RD ST # 1658 | ||||||||
| Address2: | CENTER FOR MENTAL HEALTH | ||||||||
| City: | HAVRE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 595013534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062659639 | ||||||||
| FaxNumber: | 4062656771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2011 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1535 | MT | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 0000747930 | 01 | MT | BLUE CROSS-SHIELD OF MONTANA | OTHER |