Provider Demographics
NPI:1295270668
Name:MCKINNIS, RACQUEL RENE
Entity type:Individual
Prefix:
First Name:RACQUEL
Middle Name:RENE
Last Name:MCKINNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6721 ALISA DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-3963
Mailing Address - Country:US
Mailing Address - Phone:985-400-5901
Mailing Address - Fax:
Practice Address - Street 1:6721 ALISA DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-3963
Practice Address - Country:US
Practice Address - Phone:985-400-5901
Practice Address - Fax:985-400-5164
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health