Healthcare Provider Details

I. General information

NPI: 1689364218
Provider Name (Legal Business Name): ELAINE MCKINNEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELAINE BOUSELLI MAPC

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 WASHINGTON CT
TRAPPE PA
19426-2235
US

IV. Provider business mailing address

222 WASHINGTON CT
TRAPPE PA
19426-2235
US

V. Phone/Fax

Practice location:
  • Phone: 484-301-0204
  • Fax:
Mailing address:
  • Phone: 215-469-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC012579
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: