Provider Demographics
NPI:1568782795
Name:MCKINNEY, STACY MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:MARIE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2859
Mailing Address - Country:US
Mailing Address - Phone:317-630-8485
Mailing Address - Fax:317-630-7616
Practice Address - Street 1:1001 W. 10TH ST
Practice Address - Street 2:CRISIS INTERVENTION UNIT
Practice Address - City:INDIANAPOLS
Practice Address - State:IN
Practice Address - Zip Code:46202-2859
Practice Address - Country:US
Practice Address - Phone:317-630-8485
Practice Address - Fax:317-630-7616
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006013A1041C0700X
IN87001438A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)