Provider Demographics
NPI:1982034138
Name:MCKINLEY, CAROLYN ROSE (PMHP)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ROSE
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:PMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 8TH AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-2365
Mailing Address - Country:US
Mailing Address - Phone:402-297-3034
Mailing Address - Fax:
Practice Address - Street 1:2302 8TH AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-2365
Practice Address - Country:US
Practice Address - Phone:402-297-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-24
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional