Healthcare Provider Details

I. General information

NPI: 1124954565
Provider Name (Legal Business Name): MCKENNA MARIE COLLISON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MCKENNA LYNNE LEMAY

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W BROAD AVE
FLANDREAU SD
57028-1630
US

IV. Provider business mailing address

1007 16TH ST S
BROOKINGS SD
57006-5439
US

V. Phone/Fax

Practice location:
  • Phone: 605-997-2642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC20884
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: