Provider Demographics
NPI:1346556701
Name:MCKINNEY, TAMU SHAMILLE (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMU
Middle Name:SHAMILLE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 BANDELIER LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4114
Mailing Address - Country:US
Mailing Address - Phone:817-681-5110
Mailing Address - Fax:
Practice Address - Street 1:808 BANDELIER LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4114
Practice Address - Country:US
Practice Address - Phone:817-681-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX319341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical