Basic Information
| Provider Information | |||||||||
| NPI: | 1497291082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKINNEY | ||||||||
| FirstName: | LASHUNDORA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 COLLEGE DR APT 926 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890157586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027159881 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4660 S EASTERN AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891196139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024788205 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2017 | ||||||||
| LastUpdateDate: | 10/04/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 101YP2500X | N | Behavioral Health & Social Service Providers | Counselor | Professional | 251S00000X | N | Agencies | Community/Behavioral Health | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.