Provider Demographics
NPI:1285812875
Name:MCKINLEY, MIYUME M (LCSW)
Entity type:Individual
Prefix:
First Name:MIYUME
Middle Name:M
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W 5TH ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2738
Mailing Address - Country:US
Mailing Address - Phone:424-570-6955
Mailing Address - Fax:424-363-1721
Practice Address - Street 1:302 W 5TH ST
Practice Address - Street 2:SUITE 308
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2738
Practice Address - Country:US
Practice Address - Phone:424-570-6955
Practice Address - Fax:424-363-1721
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW645551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical