Provider Demographics
NPI:1740306281
Name:MCKINNEY, K'HARA (MA)
Entity type:Individual
Prefix:
First Name:K'HARA
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 VENICE WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-4031
Mailing Address - Country:US
Mailing Address - Phone:323-632-7044
Mailing Address - Fax:
Practice Address - Street 1:12301 WILSHIRE BLVD STE 416
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1051
Practice Address - Country:US
Practice Address - Phone:323-632-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA53803106H00000X
CAMFC 49352106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program