Provider Demographics
NPI:1598800732
Name:MCKINNEY, RALPH EDMOND (PHD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:EDMOND
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 BALSAM LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1805
Mailing Address - Country:US
Mailing Address - Phone:763-559-6338
Mailing Address - Fax:
Practice Address - Street 1:10709 WAYZATA BLVD
Practice Address - Street 2:# 202
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5509
Practice Address - Country:US
Practice Address - Phone:952-544-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0948103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN44M09MCOtherBLUECROSS-OUT OF NETWORK