Provider Demographics
NPI:1588552228
Name:MCKINNEY, MIKAYLA ROSE (LBA)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:ROSE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 S PROVIDENCE RD APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-7283
Mailing Address - Country:US
Mailing Address - Phone:314-602-5622
Mailing Address - Fax:
Practice Address - Street 1:918 BERNADETTE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5007
Practice Address - Country:US
Practice Address - Phone:573-874-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst