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General NPI Number Information
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NPI Number | 1013459015
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Entity Type | Organization
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Legal Business Name | MCKINNON MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 6626 CENTRAL AVENUE PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37912-1400
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Country | US
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Telephone | 865-235-9742
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Fax |
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Provider Business Mailing Address
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Address Line | 125 E EMERALD AVE
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City | KNOXVILLE
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State | TN
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Zip | 37917-5530
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Country | US
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Telephone | 865-235-9742
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KEVIN LAROY MCKINNON
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Credential | LPC-MHSP, SAP, EAS-C
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Telephone | 865-235-9742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3176
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License Number State | TN
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