Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2016040337 | MO |
NPI | 1952954596 |
---|---|
Provider Name | Kristin Marie Mckinney-Fanning |
First Address | Clinton, MO 64735-8804 |
Second Address | Wentzville, MO 63385-4836 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2019 |
Last Update Date | 25/06/2021 |