Provider Demographics
NPI:1295001535
Name:MCKINNEY, JOHN BRENDEN (MSW; LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BRENDEN
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:MSW; LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 CRESTLINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4051
Mailing Address - Country:US
Mailing Address - Phone:307-631-5049
Mailing Address - Fax:
Practice Address - Street 1:126 CRESTLINE AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4051
Practice Address - Country:US
Practice Address - Phone:307-631-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-0751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical