Provider Demographics
NPI:1023165867
Name:MCKINNEY, CLIFFORD D (LCSW)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:D
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 69 BOX 52
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-9201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BATTIEST
Practice Address - State:OK
Practice Address - Zip Code:74722
Practice Address - Country:US
Practice Address - Phone:580-241-5294
Practice Address - Fax:580-241-5739
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG160-46-07879Medicaid