Provider Demographics
NPI:1346755147
Name:MCKINZIE, BRITTANY MORGAN (BA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MORGAN
Last Name:MCKINZIE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-2618
Mailing Address - Country:US
Mailing Address - Phone:618-664-1455
Mailing Address - Fax:618-664-1374
Practice Address - Street 1:1520 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-2618
Practice Address - Country:US
Practice Address - Phone:618-664-1455
Practice Address - Fax:618-664-1374
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)