Provider Demographics
NPI:1598096174
Name:MCKAY, SANDRA BROWN (MSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:BROWN
Last Name:MCKAY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OZARK TRAIL DR
Mailing Address - Street 2:SUITE 226
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2166
Mailing Address - Country:US
Mailing Address - Phone:636-236-7894
Mailing Address - Fax:
Practice Address - Street 1:300 OZARK TRAIL DR
Practice Address - Street 2:SUITE 226
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2166
Practice Address - Country:US
Practice Address - Phone:636-236-7894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0003341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical