Doctor Name: | RAY ALLEN MCKINNIS |
NPI Number: | 1043525934 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | |
Business Practice Address: | 1n217 Mission Ct Winfield, IL - 601902070 |
Business Phone Number: | 6306819447 |
Business Fax Number: | 6306819456 |
Mailing Address: | 1n217 Mission Ct, WINFIELD |
State: | IL |
Postal Code: | 601902070 |
Phone Number: | 6306819447 |
Fax Number: | 6306819456 |
NPI Enumeration Date: | 08/16/2010 |
NPI Last Update Date: | 08/16/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |