Provider Demographics
NPI:1013459015
Name:MCKINNON MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:MCKINNON MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LAROY
Authorized Official - Last Name:MCKINNON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP, SAP, EAS-C
Authorized Official - Phone:865-235-9742
Mailing Address - Street 1:125 E EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-5530
Mailing Address - Country:US
Mailing Address - Phone:865-235-9742
Mailing Address - Fax:
Practice Address - Street 1:6626 CENTRAL AVENUE PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-1400
Practice Address - Country:US
Practice Address - Phone:865-235-9742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty