Provider Demographics
NPI:1528410628
Name:MCKINNEY, EMILY (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 TERON DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7088
Mailing Address - Country:US
Mailing Address - Phone:512-757-4475
Mailing Address - Fax:
Practice Address - Street 1:507 TERON DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7088
Practice Address - Country:US
Practice Address - Phone:512-757-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-15-18829103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst