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General NPI Number Information
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NPI Number | 1619303567
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Entity Type | Individual
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Provider Name | RICHARD ALEXANDER MCKINLEY
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Gender | Male
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 1327 E BROADWAY ST STE B
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-1599
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Country | US
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Telephone | 270-283-4240
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Fax |
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Provider Business Mailing Address
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Address Line | 107 CRANES ROOST CT
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-3650
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Country | US
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Telephone | 270-765-2605
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Fax | 270-234-8572
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 245620
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License Number State | KY
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