Provider Information for 1205484342
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CHASE C MCKINNEY LPC
Sex: Male
NPI: 1205484342
Last Updated: 2019-09-02
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1205484342 | ||||||||
| Enumeration Date | 2019-09-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 624 RIVER ROCK DR AZLE, TX 76020-1156 United States Phone: 817-542-2111 | Fax: | ||||||||
| Primary Practice Address | 9396 CONFEDERATE PARK RD LAKESIDE, TX 76135-4916 United States Phone: 817-542-2111 | Fax: | ||||||||
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