Basic Information
| Provider Information | |||||||||
| NPI: | 1346492592 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKINNEY | ||||||||
| FirstName: | TYRONE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7396 MORNING HILLS DR | ||||||||
| Address2: | |||||||||
| City: | EASTVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928803339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102134361 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2085 RUSTIN AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925072498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9519552105 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2008 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 106695 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.