Provider Demographics
NPI:1376240192
Name:MCMINN, KALEE (CDCA)
Entity Type:Individual
Prefix:
First Name:KALEE
Middle Name:
Last Name:MCMINN
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 MERILINE AVE
Mailing Address - Street 2:
Mailing Address - City:OBETZ
Mailing Address - State:OH
Mailing Address - Zip Code:43207-4463
Mailing Address - Country:US
Mailing Address - Phone:614-972-9724
Mailing Address - Fax:614-573-7131
Practice Address - Street 1:5957 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-2210
Practice Address - Country:US
Practice Address - Phone:614-600-2979
Practice Address - Fax:614-573-7131
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH182993101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)