Provider Demographics
NPI:1710357611
Name:MCKINNEY, CELESTINE
Entity Type:Individual
Prefix:MS
First Name:CELESTINE
Middle Name:
Last Name:MCKINNEY
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 1:4378 WOODWELL ST.
Mailing Address - Street 2:UNIT D.
Mailing Address - City:LAS VEGAS
Mailing Address - State:CA
Mailing Address - Zip Code:89147-7145
Mailing Address - Country:US
Mailing Address - Phone:702-337-1299
Mailing Address - Fax:
Practice Address - Street 1:3960 E. PATRICK LANE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4902
Practice Address - Country:US
Practice Address - Phone:702-998-6264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1405116593101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor