MEDICARE: MS. PENNIE JEANINE MCKAY M.A., L.C.P.C., L.M.

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	101YM0800X	Mental Health Counselor	244	ID
2	106H00000X	Marriage & Family Therapist	2936	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010017356	OTHER	ID	BLUE SHIELD
2	259420	OTHER	ID	MANAGED HEALTH NETWORK
3	Q5779	OTHER	ID	BLUE CROSS

General Provider Information

NPI Number	:	1326138546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PENNIE JEANINE MCKAY M.A., L.C.P.C., L.M.

Provider Business Mailing Address
First Line	:	1674 W HILL RD
Second Line	:	SUITE #7
City	:	BOISE
State	:	ID
Zip	:	83702-0958
Country	:	US
Telephone Number	:	208-345-1552
Fax Number	:	208-345-1552

Provider Business Practice Location Address
First Line	:	1674 HILL RD
Second Line	:	SUITE #7
City	:	BOISE
State	:	ID
Zip	:	83702-0958
Country	:	US
Telephone Number	:	208-345-1552
Fax Number	:	208-345-1552

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	09/11/2025

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