Provider Demographics
NPI:1699423764
Name:MCKINLEY, KEHIANTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KEHIANTE
Middle Name:
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S MARKET ST # 112
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1712
Mailing Address - Country:US
Mailing Address - Phone:406-868-5508
Mailing Address - Fax:
Practice Address - Street 1:419 S EUCALYPTUS AVE UNIT B
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2605
Practice Address - Country:US
Practice Address - Phone:818-253-9441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35488103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist