Provider Demographics
NPI:1023455128
Name:MCKINLEY, KANDYS RENEE' (MED, LPC, LSOTP)
Entity type:Individual
Prefix:
First Name:KANDYS
Middle Name:RENEE'
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:MED, LPC, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9896 BISSONNET ST STE 131
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8104
Mailing Address - Country:US
Mailing Address - Phone:832-705-9208
Mailing Address - Fax:
Practice Address - Street 1:2147 DIAMOND CREST DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3285
Practice Address - Country:US
Practice Address - Phone:832-816-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX320497601Medicaid