Provider Demographics
NPI:1730971243
Name:MCCOY, CONNER WILLIAM (LLMSW)
Entity type:Individual
Prefix:
First Name:CONNER
Middle Name:WILLIAM
Last Name:MCCOY
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:48721-9752
Mailing Address - Country:US
Mailing Address - Phone:989-916-9319
Mailing Address - Fax:
Practice Address - Street 1:400 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1434
Practice Address - Country:US
Practice Address - Phone:989-356-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511202011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical