Provider Demographics
NPI:1619399409
Name:MCKINNEY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MCKINNEY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:203-917-3695
Mailing Address - Street 1:15 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5604
Mailing Address - Country:US
Mailing Address - Phone:203-917-3695
Mailing Address - Fax:203-917-3697
Practice Address - Street 1:15 NORTH ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5604
Practice Address - Country:US
Practice Address - Phone:203-917-3695
Practice Address - Fax:203-917-3697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000929101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty