Provider Demographics
NPI:1013326057
Name:MCKINNEY, KISA (LMFT)
Entity Type:Individual
Prefix:
First Name:KISA
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21009 GREEN HILL RD APT 366
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-4518
Mailing Address - Country:US
Mailing Address - Phone:909-938-9181
Mailing Address - Fax:
Practice Address - Street 1:27620 FARMINGTON RD STE 201
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3368
Practice Address - Country:US
Practice Address - Phone:248-579-5513
Practice Address - Fax:248-479-2578
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006769106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist