MEDICARE: BECKY MULVIHILL MCKENNA PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW003112	MO
2	106H00000X	Marriage & Family Therapist	MF300098	MO

General Provider Information

NPI Number	:	1013196336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKY MULVIHILL MCKENNA PH.D.

Provider Business Mailing Address
First Line	:	7349 DALE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-2241
Country	:	US
Telephone Number	:	314-645-6686
Fax Number	:

Provider Business Practice Location Address
First Line	:	7349 DALE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-2241
Country	:	US
Telephone Number	:	314-645-6686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	11/02/2007

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