Provider Demographics
NPI:1326138546
Name:MCKAY, PENNIE JEANINE (MA, LCPC, LM)
Entity Type:Individual
Prefix:MS
First Name:PENNIE
Middle Name:JEANINE
Last Name:MCKAY
Suffix:
Gender:F
Credentials:MA, LCPC, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 W HILL RD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0958
Mailing Address - Country:US
Mailing Address - Phone:208-345-1552
Mailing Address - Fax:208-345-1552
Practice Address - Street 1:1674 HILL RD
Practice Address - Street 2:SUITE #7
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-0958
Practice Address - Country:US
Practice Address - Phone:208-345-1552
Practice Address - Fax:208-345-1552
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID244101YM0800X
ID2936106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010017356OtherBLUE SHIELD
ID259420OtherMANAGED HEALTH NETWORK
IDQ5779OtherBLUE CROSS