Healthcare Provider Details

I. General information

NPI: 1689165433
Provider Name (Legal Business Name): TABITHA K MCKINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 OHIO PIKE STE 214N
CINCINNATI OH
45255-3629
US

IV. Provider business mailing address

431 OHIO PIKE STE 214N
CINCINNATI OH
45255-3629
US

V. Phone/Fax

Practice location:
  • Phone: 513-655-6911
  • Fax:
Mailing address:
  • Phone: 513-655-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2406603
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC.2305140-TRNE
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: