Provider Demographics
NPI:1174847693
Name:MCKEE, GINA (MS, MA, LCPC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MCKEE
Suffix:
Gender:F
Credentials:MS, MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 BRADLEY ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7627
Mailing Address - Country:US
Mailing Address - Phone:618-727-0819
Mailing Address - Fax:
Practice Address - Street 1:220 E STATE ST
Practice Address - Street 2:SUITE 2G
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1443
Practice Address - Country:US
Practice Address - Phone:618-727-0819
Practice Address - Fax:618-206-8649
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007543101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL351786086001Medicaid