Provider Demographics
NPI:1669124111
Name:MCKINLEY, ELIZABETH JEAN (LPC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JEAN
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2613
Mailing Address - Country:US
Mailing Address - Phone:720-982-8931
Mailing Address - Fax:
Practice Address - Street 1:1209 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2613
Practice Address - Country:US
Practice Address - Phone:720-982-8931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional