Provider Demographics
NPI:1952741506
Name:MCKINNEY, RITA ISABEL (LMFT)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:ISABEL
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:ISABEL
Other - Last Name:MEJIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1099 TAUTOG CIR
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98315-1012
Mailing Address - Country:US
Mailing Address - Phone:360-315-3070
Mailing Address - Fax:
Practice Address - Street 1:2130 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-2209
Practice Address - Country:US
Practice Address - Phone:619-255-5172
Practice Address - Fax:619-269-0464
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99697106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist