Provider Demographics
NPI:1043525934
Name:MCKINNIS, RAY ALLEN (PHD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:ALLEN
Last Name:MCKINNIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1N217 MISSION CT
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2070
Mailing Address - Country:US
Mailing Address - Phone:630-681-9447
Mailing Address - Fax:630-681-9456
Practice Address - Street 1:1N217 MISSION CT
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2070
Practice Address - Country:US
Practice Address - Phone:630-681-9447
Practice Address - Fax:630-681-9456
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health