Provider Demographics
NPI:1750124657
Name:MCKINNON, ASHLEY BRIANNE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BRIANNE
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 GIOTTO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8577
Mailing Address - Country:US
Mailing Address - Phone:916-770-7550
Mailing Address - Fax:
Practice Address - Street 1:45 CAMINO ALTO STE 208
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2935
Practice Address - Country:US
Practice Address - Phone:415-528-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16602101YM0800X
CA146864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health