Provider Demographics
NPI:1093139966
Name:MCKINNIE, MICHELLE (LCPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCKINNIE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N OTTAWA ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-4006
Mailing Address - Country:US
Mailing Address - Phone:815-730-4891
Mailing Address - Fax:815-730-4918
Practice Address - Street 1:2121 ONEIDA ST
Practice Address - Street 2:SUITE 304
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6544
Practice Address - Country:US
Practice Address - Phone:815-730-4891
Practice Address - Fax:815-730-4918
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional