Provider Demographics
NPI:1134745334
Name:MACKEY, KELVIN D'ANTREY (LMHC)
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:D'ANTREY
Last Name:MACKEY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 CEDAR PLAZA DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2286
Mailing Address - Country:US
Mailing Address - Phone:563-554-2251
Mailing Address - Fax:
Practice Address - Street 1:2016 CEDAR PLAZA DR
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2883
Practice Address - Country:US
Practice Address - Phone:563-554-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty