MEDICARE: JAMES ROBERT MCKINNEY 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	M0405211157	CA

General Provider Information

NPI Number	:	1851448278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ROBERT MCKINNEY PH.D.

Provider Business Mailing Address
First Line	:	2452 NUTWOOD AVE
Second Line	:	APARTMENT D30
City	:	FULLERTON
State	:	CA
Zip	:	92831-3144
Country	:	US
Telephone Number	:	714-470-6959
Fax Number	:

Provider Business Practice Location Address
First Line	:	2321 PONTIUS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1809
Country	:	US
Telephone Number	:	310-478-8066
Fax Number	:	310-478-8821

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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