Provider Demographics
NPI:1609568468
Name:MCANALLY, KACI RENEE
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:RENEE
Last Name:MCANALLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 ABERDEEN WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9554
Mailing Address - Country:US
Mailing Address - Phone:682-251-1313
Mailing Address - Fax:
Practice Address - Street 1:4917 GOLDEN TRIANGLE BLVD STE 411
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4672
Practice Address - Country:US
Practice Address - Phone:817-734-6515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician