Provider Demographics
NPI:1013196336
Name:MCKENNA, BECKY MULVIHILL (PHD)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:MULVIHILL
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:M
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:7349 DALE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2241
Mailing Address - Country:US
Mailing Address - Phone:314-645-6686
Mailing Address - Fax:
Practice Address - Street 1:7349 DALE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-2241
Practice Address - Country:US
Practice Address - Phone:314-645-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0031121041C0700X
MOMF300098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical