Provider Demographics
NPI:1275285967
Name:MCKINLEY, JANNA (LMFT-A)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 CROSSFIRE TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-3708
Mailing Address - Country:US
Mailing Address - Phone:817-675-5585
Mailing Address - Fax:
Practice Address - Street 1:7404 CROSSFIRE TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-3708
Practice Address - Country:US
Practice Address - Phone:817-675-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty