Provider Demographics
NPI:1871246843
Name:MCKEEVER, MARILYNN
Entity Type:Individual
Prefix:
First Name:MARILYNN
Middle Name:
Last Name:MCKEEVER
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 1:3025 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-4534
Mailing Address - Country:US
Mailing Address - Phone:626-765-6905
Mailing Address - Fax:
Practice Address - Street 1:3025 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-4534
Practice Address - Country:US
Practice Address - Phone:626-765-6905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI2221214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)