Provider Demographics
NPI:1114478278
Name:MCKINNEY, TRISHA NELL (TLLP)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:NELL
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE CLOUD
Mailing Address - State:MI
Mailing Address - Zip Code:49349-9426
Mailing Address - Country:US
Mailing Address - Phone:231-730-7733
Mailing Address - Fax:
Practice Address - Street 1:753 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-9426
Practice Address - Country:US
Practice Address - Phone:231-730-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016878103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling