Provider Demographics
NPI:1750661559
Name:MCKENNA, TIMOTHY D (BA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:D
Last Name:MCKENNA
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Gender:M
Credentials:BA
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Mailing Address - Street 1:480 GALLETTI WY
Mailing Address - Street 2:8B & 8C
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436
Mailing Address - Country:US
Mailing Address - Phone:775-324-1490
Mailing Address - Fax:775-324-1541
Practice Address - Street 1:480 GALLETTI WY
Practice Address - Street 2:8B & 8C
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436
Practice Address - Country:US
Practice Address - Phone:775-324-1490
Practice Address - Fax:775-324-1541
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2012-04-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health