Provider Demographics
NPI:1245698604
Name:MCKINSTRY, ANGELA LYNNE (BA SOCIOLOGY, MATS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNNE
Last Name:MCKINSTRY
Suffix:
Gender:F
Credentials:BA SOCIOLOGY, MATS
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Mailing Address - Street 1:1415 MCTAVISH DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-1407
Mailing Address - Country:US
Mailing Address - Phone:812-256-4686
Mailing Address - Fax:812-256-4415
Practice Address - Street 1:1415 MCTAVISH DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-1407
Practice Address - Country:US
Practice Address - Phone:812-256-4686
Practice Address - Fax:812-256-4415
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN101YA0400XMedicaid