Provider Demographics
NPI:1962068577
Name:MCKENNEY, TRACY R (LCPC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:R
Last Name:MCKENNEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 S INDIANA AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3645
Mailing Address - Country:US
Mailing Address - Phone:815-408-1262
Mailing Address - Fax:
Practice Address - Street 1:187 S INDIANA AVE STE 307
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3645
Practice Address - Country:US
Practice Address - Phone:815-408-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36495101YA0400X
IL180015161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)