Provider Demographics
NPI:1336663327
Name:MCKINLEY, OVETA (LMSW)
Entity Type:Individual
Prefix:
First Name:OVETA
Middle Name:
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23823 VILLAGE HOUSE DR S APT 6B
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2611
Mailing Address - Country:US
Mailing Address - Phone:313-850-8153
Mailing Address - Fax:
Practice Address - Street 1:14200 PURITAN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3323
Practice Address - Country:US
Practice Address - Phone:313-659-6958
Practice Address - Fax:313-659-6954
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010781771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical