Provider Demographics
NPI:1609631274
Name:MCKINNEY, LUCIAN JEROME III
Entity type:Individual
Prefix:
First Name:LUCIAN
Middle Name:JEROME
Last Name:MCKINNEY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 SHELDON RD UNIT 48102
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7279
Mailing Address - Country:US
Mailing Address - Phone:916-937-4103
Mailing Address - Fax:
Practice Address - Street 1:4144 WINDING WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4413
Practice Address - Country:US
Practice Address - Phone:916-737-1481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist