Healthcare Provider Details

I. General information

NPI: 1588791289
Provider Name (Legal Business Name): JULIE ANNE MCKINLEY M.A., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 JUAN TABO BLVD NE SUITE 20
ALBUQUERQUE NM
87111-3984
US

IV. Provider business mailing address

3900 JUAN TABO BLVD NE SUITE 20
ALBUQUERQUE NM
87111-3984
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-6462
  • Fax: 505-298-3939
Mailing address:
  • Phone: 505-275-6462
  • Fax: 505-298-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC 4082
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: