Provider Demographics
NPI:1841675634
Name:MCKINNEY, MARIJKE ROSE
Entity type:Individual
Prefix:
First Name:MARIJKE
Middle Name:ROSE
Last Name:MCKINNEY
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 1:154 W MARIPOSA APT C
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-6426
Mailing Address - Country:US
Mailing Address - Phone:949-374-3584
Mailing Address - Fax:
Practice Address - Street 1:505 N EUCLID ST STE 300
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5514
Practice Address - Country:US
Practice Address - Phone:714-871-5646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health