Provider Demographics
NPI:1134484967
Name:MCKINNEY, AYRON LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:AYRON
Middle Name:LEE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3035
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49003-3035
Mailing Address - Country:US
Mailing Address - Phone:269-579-0523
Mailing Address - Fax:
Practice Address - Street 1:215 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4257
Practice Address - Country:US
Practice Address - Phone:269-579-0523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010881591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical