Provider Demographics
NPI:1164113973
Name:MCKINNEY, MIKE LEE (BA)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:LEE
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:BA
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 400
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:WV
Mailing Address - Zip Code:25878-0400
Mailing Address - Country:US
Mailing Address - Phone:304-894-2007
Mailing Address - Fax:
Practice Address - Street 1:1021 QUARRIER ST STE 310
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2338
Practice Address - Country:US
Practice Address - Phone:304-894-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor