Provider Demographics
NPI:1255684692
Name:MCKINNEY, KATHLEEN GLADYS (PHD, LSW, CSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:GLADYS
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:PHD, LSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5252
Mailing Address - Country:US
Mailing Address - Phone:970-556-2729
Mailing Address - Fax:970-236-9260
Practice Address - Street 1:5131 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3968
Practice Address - Country:US
Practice Address - Phone:970-305-2399
Practice Address - Fax:970-236-9260
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW-243104100000X
COCSW-99230841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14146383OtherANTHEM/BLUE CROSS
CO14146383OtherANTHEM/BLUE CROSS