Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1043788136 |
---|---|
Provider Name | Dr. Kellye D Mckinna |
First Address | Malibu, CA 90265-3944 |
Second Address | Malibu, CA 90265-3944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2018 |
Last Update Date | 06/11/2018 |