Provider Demographics
NPI:1295305548
Name:MCKEE, JACKLYN NICOLE (CATC-1)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:NICOLE
Last Name:MCKEE
Suffix:
Gender:F
Credentials:CATC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10751 DALE AVE
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-2604
Mailing Address - Country:US
Mailing Address - Phone:714-821-5311
Mailing Address - Fax:
Practice Address - Street 1:8086 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-5941
Practice Address - Country:US
Practice Address - Phone:949-337-1439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213178101YA0400X
CA2313178101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)