Basic Information
| Provider Information | |||||||||
| NPI: | 1154423531 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKINNEY | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS PCC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WARNER | ||||||||
| OtherFirstName: | BRENDA | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 840 | ||||||||
| Address2: | 87 STAMBAUGH AVENUE SUITE 5 | ||||||||
| City: | SHARON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249820414 | ||||||||
| FaxNumber: | 7249824407 | ||||||||
| Practice Location | |||||||||
| Address1: | 87 STAMBAUGH AVENUE | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | SHARON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249820414 | ||||||||
| FaxNumber: | 7249824407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | E4190 | OH | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.