Provider Demographics
NPI:1366567836
Name:MCKAY, KENNETH RICHARD (PHD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RICHARD
Last Name:MCKAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5516 S. FORT APACHE STE. 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:866-518-0781
Mailing Address - Fax:866-518-0781
Practice Address - Street 1:5516 S. FORT APACHE STE. 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:866-518-0781
Practice Address - Fax:866-518-0781
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0522103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist