Provider Demographics
NPI:1720010465
Name:MCKINNEY, PAMELA JEAN (LCSW LMFT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JEAN
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 FULTON ST
Mailing Address - Street 2:ATTN: ANNE LAWSON
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1577
Mailing Address - Country:US
Mailing Address - Phone:574-205-2600
Mailing Address - Fax:
Practice Address - Street 1:118 N SALLY DR
Practice Address - Street 2:
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-9100
Practice Address - Country:US
Practice Address - Phone:574-946-4233
Practice Address - Fax:574-946-4365
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001175A106H00000X
IN34001702A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000184325OtherANTHEM
IN000000184325OtherANTHEM
IN132770000OtherMAGELLAN BEHAVIORAL
IN650012951Medicare ID - Type UnspecifiedMEDICARE RAILROAD