Provider Demographics
NPI:1912147299
Name:MCKEE, JUDSON C (MSED, PMFT)
Entity Type:Individual
Prefix:
First Name:JUDSON
Middle Name:C
Last Name:MCKEE
Suffix:
Gender:M
Credentials:MSED, PMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 BIG HORN AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9299
Mailing Address - Country:US
Mailing Address - Phone:307-587-2197
Mailing Address - Fax:
Practice Address - Street 1:2538 BIG HORN AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9299
Practice Address - Country:US
Practice Address - Phone:307-587-2197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLMFT-148171M00000X, 172V00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker