Provider Demographics
NPI:1861099061
Name:MCCORD, JUSTIN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MCCORD
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 RED HILL CENTER RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-6842
Mailing Address - Country:US
Mailing Address - Phone:931-242-2502
Mailing Address - Fax:
Practice Address - Street 1:454 RED HILL CENTER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-6842
Practice Address - Country:US
Practice Address - Phone:931-242-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-170258363LP0808X
TN28188363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health