Provider Demographics
NPI:1801229687
Name:MCKINNEY, MIRANDA HOPE TURNAGE
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:HOPE TURNAGE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:HOPE
Other - Last Name:TURNAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 SE AVE H
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-5038
Mailing Address - Country:US
Mailing Address - Phone:580-212-0013
Mailing Address - Fax:
Practice Address - Street 1:211 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4036
Practice Address - Country:US
Practice Address - Phone:580-326-5279
Practice Address - Fax:580-326-8047
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health