Provider Demographics
NPI:1083896757
Name:MICHELE C. MCKINNIE, PSY.D., PC
Entity Type:Organization
Organization Name:MICHELE C. MCKINNIE, PSY.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:MCKINNIE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:406-582-1321
Mailing Address - Street 1:1648 ELLIS ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8810
Mailing Address - Country:US
Mailing Address - Phone:406-582-1321
Mailing Address - Fax:406-587-1513
Practice Address - Street 1:1648 ELLIS ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8810
Practice Address - Country:US
Practice Address - Phone:406-582-1321
Practice Address - Fax:406-587-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty