Provider Demographics
NPI:1821725953
Name:MCKINESS, SHALLEN
Entity Type:Individual
Prefix:
First Name:SHALLEN
Middle Name:
Last Name:MCKINESS
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 1:6610 S 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-5302
Mailing Address - Country:US
Mailing Address - Phone:520-217-0445
Mailing Address - Fax:
Practice Address - Street 1:6610 S 23RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5302
Practice Address - Country:US
Practice Address - Phone:520-217-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health