Provider Demographics
NPI:1992306880
Name:MCKINLEY, ERIC BENJAMIN (MS,LPC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:BENJAMIN
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1703
Mailing Address - Country:US
Mailing Address - Phone:575-571-5677
Mailing Address - Fax:
Practice Address - Street 1:1580 N KOLB RD STE 200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4933
Practice Address - Country:US
Practice Address - Phone:520-827-6372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-19256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health