Provider Demographics
NPI:1831942986
Name:MCKINSEY, BENNY FRANK JR (RSW)
Entity type:Individual
Prefix:
First Name:BENNY
Middle Name:FRANK
Last Name:MCKINSEY
Suffix:JR
Gender:M
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 CLAIBORNE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4301
Mailing Address - Country:US
Mailing Address - Phone:318-779-0434
Mailing Address - Fax:
Practice Address - Street 1:2219 CLAIBORNE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4301
Practice Address - Country:US
Practice Address - Phone:318-779-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10472104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker