Healthcare Provider Details

I. General information

NPI: 1538751292
Provider Name (Legal Business Name): JOSEPH MCKINNEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S EASTGATE AVE
SPRINGFIELD MO
65809-2146
US

IV. Provider business mailing address

1011 N 26TH ST
OZARK MO
65721-7895
US

V. Phone/Fax

Practice location:
  • Phone: 855-593-4357
  • Fax:
Mailing address:
  • Phone: 417-501-4896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2023012469
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: