Healthcare Provider Details

I. General information

NPI: 1831164847
Provider Name (Legal Business Name): BRENDA FAYE MCKINNEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W GREEN MEADOWS DR SUITE 1
GREENFIELD IN
46140-4002
US

IV. Provider business mailing address

8180 CLEARVISTA PARKWAY SUITE 230 ATTN SHERRY MUELLER
INDIANAPOLIS IN
46256-4649
US

V. Phone/Fax

Practice location:
  • Phone: 317-462-1481
  • Fax:
Mailing address:
  • Phone: 317-621-7561
  • Fax: 317-621-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34002939A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: