Healthcare Provider Details

I. General information

NPI: 1407900459
Provider Name (Legal Business Name): MARY A MCKINNELL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ANN HEILEMEIER AND DECKER

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E LOCUST ST STE 126
DES MOINES IA
50309-1955
US

IV. Provider business mailing address

PO BOX 672
ANKENY IA
50021-0672
US

V. Phone/Fax

Practice location:
  • Phone: 515-216-0109
  • Fax: 515-295-0005
Mailing address:
  • Phone: 515-216-0109
  • Fax: 515-295-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number107880
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: