Provider Demographics
NPI:1821336645
Name:MCKINNEY, BRENDA JOY (BS, MS)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JOY
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 HOLLINS HALL ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8717
Mailing Address - Country:US
Mailing Address - Phone:702-510-1058
Mailing Address - Fax:
Practice Address - Street 1:371 HOLLINS HALL ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8717
Practice Address - Country:US
Practice Address - Phone:702-510-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation