Provider Demographics
NPI:1326800327
Name:DEATON, MCKENNA BROOKE
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:BROOKE
Last Name:DEATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 REDDING RD APT 56
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-2369
Mailing Address - Country:US
Mailing Address - Phone:606-233-7786
Mailing Address - Fax:
Practice Address - Street 1:395 REDDING RD APT 56
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-2369
Practice Address - Country:US
Practice Address - Phone:606-233-7786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2583501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty