Basic Information
| Provider Information | |||||||||
| NPI: | 1669771739 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKINNEY | ||||||||
| FirstName: | MICHAELE | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | TULARE COUNTY MENTAL HEALTH | ||||||||
| Address2: | 520 EAST TULARE AVENUE | ||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596230900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | TULARE COUNTY MENTAL HEALTH | ||||||||
| Address2: | 520 E TULARE AVENUE | ||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932921102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596230990 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2011 | ||||||||
| LastUpdateDate: | 08/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 132978 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 390200000X | 206099 | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | 132978 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.