Basic Information
| Provider Information | |||||||||
| NPI: | 1740651892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKELL-JEFFERS | ||||||||
| FirstName: | RAHSAAN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 W. KILGORE AVE | ||||||||
| Address2: | YOUTH OPPORTUNITY CENTER | ||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473049008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652895437 | ||||||||
| FaxNumber: | 7657415269 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 W. KILGORE AVE | ||||||||
| Address2: | YOUTH OPPORTUNITY CENTER | ||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652895437 | ||||||||
| FaxNumber: | 7657415269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2015 | ||||||||
| LastUpdateDate: | 10/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.