Provider Demographics
NPI:1154802254
Name:MCKINNON, ROLICIA DANAE
Entity type:Individual
Prefix:
First Name:ROLICIA
Middle Name:DANAE
Last Name:MCKINNON
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 1:3140 W BRITTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2039
Mailing Address - Country:US
Mailing Address - Phone:405-607-6292
Mailing Address - Fax:405-607-6307
Practice Address - Street 1:3140 W BRITTON RD STE 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2039
Practice Address - Country:US
Practice Address - Phone:405-607-6292
Practice Address - Fax:405-607-6307
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty