Provider Demographics
NPI:1558791970
Name:MCKINLEY, MARY TEMITOPE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:TEMITOPE
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:TEMITOPE
Other - Last Name:AKINWOLEMIWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:718 E SHEILA CIR
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-2924
Mailing Address - Country:US
Mailing Address - Phone:214-603-1278
Mailing Address - Fax:
Practice Address - Street 1:2201 SE LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-5863
Practice Address - Country:US
Practice Address - Phone:817-730-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39644103TC0700X
TX65824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health