MEDICARE: JENNIFER LEE MCKINNEY LMFT

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	106H00000X	Marriage & Family Therapist	41568	CA

General Provider Information

NPI Number	:	1083787642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LEE MCKINNEY LMFT

Provider Business Mailing Address
First Line	:	1076 APPLE CT
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94518-3101
Country	:	US
Telephone Number	:	925-825-4763
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 PACIFICA AVE
Second Line	:
City	:	BAY POINT
State	:	CA
Zip	:	94565-2904
Country	:	US
Telephone Number	:	925-458-3216
Fax Number	:

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	02/11/2022

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