Provider Demographics
NPI:1962913301
Name:MCKINNEY, LEAH ANN (LCPC-8805)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:ANN
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:LCPC-8805
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 RUSTIC DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-3078
Mailing Address - Country:US
Mailing Address - Phone:801-564-4393
Mailing Address - Fax:
Practice Address - Street 1:1015 GAMMON LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2210
Practice Address - Country:US
Practice Address - Phone:208-736-7090
Practice Address - Fax:208-736-7089
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-8005101YM0800X
WI11095-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health