Provider Demographics
NPI:1932328481
Name:MCKINSTRY, CAROLLYN F (MA, LCPC, LPCC)
Entity Type:Individual
Prefix:
First Name:CAROLLYN
Middle Name:F
Last Name:MCKINSTRY
Suffix:
Gender:F
Credentials:MA, LCPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 S HILL RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6129
Mailing Address - Country:US
Mailing Address - Phone:805-628-2721
Mailing Address - Fax:
Practice Address - Street 1:1300 EASTMAN AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-8004
Practice Address - Country:US
Practice Address - Phone:805-628-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006239101YP2500X
CALPCC9865101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional