Provider Demographics
NPI:1366105793
Name:KINNEY, SHANE M (EDD LMHC)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:M
Last Name:KINNEY
Suffix:
Gender:M
Credentials:EDD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9408 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2407
Mailing Address - Country:US
Mailing Address - Phone:786-472-2400
Mailing Address - Fax:786-220-1565
Practice Address - Street 1:9408 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2407
Practice Address - Country:US
Practice Address - Phone:786-472-2400
Practice Address - Fax:786-220-1565
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty