Provider Demographics
NPI:1073547253
Name:MCKINNON, LOUISA (MA, MFT)
Entity Type:Individual
Prefix:
First Name:LOUISA
Middle Name:
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MCKINNON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:PO BOX 990400
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-0400
Mailing Address - Country:US
Mailing Address - Phone:530-229-7744
Mailing Address - Fax:530-229-7707
Practice Address - Street 1:1923 COURT ST
Practice Address - Street 2:SUITE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1824
Practice Address - Country:US
Practice Address - Phone:530-229-7744
Practice Address - Fax:530-229-7707
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40186106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist