Provider Demographics
NPI:1932944576
Name:JOHNSEN, MCKAY WILLIAM
Entity type:Individual
Prefix:
First Name:MCKAY
Middle Name:WILLIAM
Last Name:JOHNSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 CHEROKEE ST APT 404
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3649
Mailing Address - Country:US
Mailing Address - Phone:805-689-3100
Mailing Address - Fax:
Practice Address - Street 1:1250 CHEROKEE ST APT 404
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3649
Practice Address - Country:US
Practice Address - Phone:805-689-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSWC.00000020511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical