Provider Demographics
NPI:1255327581
Name:MCKECHNIE, THERESE K (LSCSW)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:K
Last Name:MCKECHNIE
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2241
Mailing Address - Country:US
Mailing Address - Phone:913-362-0315
Mailing Address - Fax:913-362-0394
Practice Address - Street 1:10000 W 75TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2219
Practice Address - Country:US
Practice Address - Phone:913-362-0315
Practice Address - Fax:913-362-0394
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0004772Medicare ID - Type Unspecified