Healthcare Provider Details

I. General information

NPI: 1821306549
Provider Name (Legal Business Name): TRICIA MCKINNEY, PSY,D., LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 E ALGONQUIN RD
SCHAUMBURG IL
60173-4188
US

IV. Provider business mailing address

1722 N WATERMAN AVE
ARLINGTON HEIGHTS IL
60004-4252
US

V. Phone/Fax

Practice location:
  • Phone: 847-306-9623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.007472
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.007795
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149007413
License Number StateIL

VIII. Authorized Official

Name: DR. TRICIA MCKINNEY
Title or Position: CLINICAL PSYCHOLOGIST
Credential:
Phone: 847-791-2851