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General NPI Number Information
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NPI Number | 1669771739
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Entity Type | Individual
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Provider Name | MICHAELE DIANE MCKINNEY AMFT, CADC-II
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Gender | Female
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | SILVER LAKE PSYCHOLOGY INC. 4325 SUNSET BLVD, UNIT 206
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City | LOS ANGELES
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State | CA
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Zip | 90029
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Country | US
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Telephone | 310-809-8004
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Fax |
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Provider Business Mailing Address
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Address Line | SILVER LAKE PSYCHOLOGY INC. 4325 SUNSET BLVD., UNIT 206
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City | LOS ANGELES
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State | CA
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Zip | 90029
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Country | US
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Telephone | 800-726-3890
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 109031
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 132978
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 206099
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 132978
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License Number State | CA
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