Provider Demographics
NPI:1649997784
Name:MCKINNEY, KRISTI (CADC III, QMHP-C)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:CADC III, QMHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 NE 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2743
Mailing Address - Country:US
Mailing Address - Phone:503-545-2406
Mailing Address - Fax:
Practice Address - Street 1:2209 LLOYD CTR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1315
Practice Address - Country:US
Practice Address - Phone:503-231-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21-04-30011101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)