Healthcare Provider Details

I. General information

NPI: 1619552429
Provider Name (Legal Business Name): JONATHAN MCKINNEY QBHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 WASHINGTON AVE STE 501
SAINT LOUIS MO
63101-1272
US

IV. Provider business mailing address

1405 W PINHOOK RD
LAFAYETTE LA
70503-3100
US

V. Phone/Fax

Practice location:
  • Phone: 888-441-3959
  • Fax: 888-649-8931
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2026038892
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: