Provider Demographics
NPI:1548227150
Name:MCKINNEY BOTEFUHR, DAWN CHAREE (MED, LPC-S, NCC)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:CHAREE
Last Name:MCKINNEY BOTEFUHR
Suffix:
Gender:F
Credentials:MED, LPC-S, NCC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2625 N JOSEY LN
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5543
Mailing Address - Country:US
Mailing Address - Phone:972-466-2800
Mailing Address - Fax:972-466-2810
Practice Address - Street 1:2625 N JOSEY LN
Practice Address - Street 2:SUITE 250
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5543
Practice Address - Country:US
Practice Address - Phone:972-466-2800
Practice Address - Fax:972-466-2810
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX07246LCOtherBCBS
TX458035OtherNORTHSTAR
TX10042808OtherAMERIGROUP
TX458035OtherVALUE OPTIONS
TX095659104Medicaid
TX11604965OtherCAQH
TX7724855OtherAETNA