Basic Information
| Provider Information | |||||||||
| NPI: | 1568757789 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKINNEY | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | MS, MFT INTERN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58967 BUSINESS CENTER DR | ||||||||
| Address2: | |||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922847308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609468200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 58967 BUSINESS CENTER DR | ||||||||
| Address2: | |||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922847308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609468200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2011 | ||||||||
| LastUpdateDate: | 01/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMF 68467 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | IMF 68467 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 103208 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.