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General NPI Number Information
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NPI Number | 1447410337
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Entity Type | Individual
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Provider Name | LAURA JEAN MCKAY MFT INTERN
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Gender | Female
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 12968 FREDERICK ST STE A
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City | MORENO VALLEY
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State | CA
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Zip | 92553-5229
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Country | US
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Telephone | 951-662-4708
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Fax |
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Provider Business Mailing Address
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Address Line | 12968 FREDERICK ST STE A
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City | MORENO VALLEY
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State | CA
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Zip | 92553-5229
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Country | US
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Telephone | 951-662-4708
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | IMF 56251
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF 56251
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License Number State | CA
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