Provider Demographics
NPI:1275215253
Name:MCKINNEY, JENNIFER JANE (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JANE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JANE
Other - Last Name:NEVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SCHOOL COUNSELOR
Mailing Address - Street 1:457C ROAD 3000
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-9653
Mailing Address - Country:US
Mailing Address - Phone:505-801-7075
Mailing Address - Fax:
Practice Address - Street 1:457C ROAD 3000
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-9653
Practice Address - Country:US
Practice Address - Phone:505-801-7075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health