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NPI Code Detail

MEDICARE: TOMMY D MCKINNEY LPC

MEDICARE: TOMMY D MCKINNEY LPC
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
1101YP2500XProfessional Counselor0002671MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1117595OTHERMOBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538263025
Entity Type Code : Individual
Provider Name (Legal Business Name) : TOMMY D MCKINNEY LPC
Provider Business Mailing Address
First Line : 402 S SILVER SPRINGS RD
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63703-7536
Country : US
Telephone Number : 573-334-1100
Fax Number : 573-651-4345
Provider Business Practice Location Address
First Line : 402 S SILVER SPRINGS RD
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63703-7536
Country : US
Telephone Number : 573-334-1100
Fax Number : 573-651-4345
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 12/27/2011

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Directions to “ TOMMY D MCKINNEY LPC” Practice Location

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