Provider Demographics
NPI:1104329705
Name:MCKINNEY, EMILY (MA, BC-DMT, LPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MA, BC-DMT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7825 DEVON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3503
Mailing Address - Country:US
Mailing Address - Phone:215-534-4844
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 2100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6211
Practice Address - Country:US
Practice Address - Phone:215-545-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007559101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional