=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497519862
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCKINLEY COUNSELING FIRM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2024
-----------------------------------------------------
Last Update Date | 02/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2591 N HIGHWAY 77 STE 107
-----------------------------------------------------
City | WAXAHACHIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75165-6132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-966-5152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2824 MCCORMICK DR
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75134-1999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-966-5152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WANDA RENEE WASHINGTON MCKINLEY
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 214-966-5152
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------