Provider Demographics
NPI:1740651892
Name:MCKELL-JEFFERS, RAHSAAN A (MA)
Entity type:Individual
Prefix:
First Name:RAHSAAN
Middle Name:A
Last Name:MCKELL-JEFFERS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W. KILGORE AVE
Mailing Address - Street 2:YOUTH OPPORTUNITY CENTER
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-9008
Mailing Address - Country:US
Mailing Address - Phone:765-289-5437
Mailing Address - Fax:765-741-5269
Practice Address - Street 1:3700 W. KILGORE AVE
Practice Address - Street 2:YOUTH OPPORTUNITY CENTER
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304
Practice Address - Country:US
Practice Address - Phone:765-289-5437
Practice Address - Fax:765-741-5269
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health