Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 2008026355 | MO |
NPI | 1568793487 |
---|---|
Provider Name | Timothy A Mckay |
First Address | Kirkwood, MO 63122-3609 |
Second Address | Saint Louis, MO 63108-2914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2010 |
Last Update Date | 10/02/2017 |