Provider Demographics
NPI:1255705695
Name:MCKINSTRY, MASHAVU RENEE (MA, LLPC)
Entity type:Individual
Prefix:MRS
First Name:MASHAVU
Middle Name:RENEE
Last Name:MCKINSTRY
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6064 GRANDVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3943
Mailing Address - Country:US
Mailing Address - Phone:313-254-7499
Mailing Address - Fax:
Practice Address - Street 1:6064 GRANDVILLE AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3943
Practice Address - Country:US
Practice Address - Phone:313-254-7499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional