Individual
LISA SHAUREE MCKINNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2733
(682) 885-4157
Mailing address
10401 FORT TERAN TRL, CROWLEY, TX 76036-3887
(817) 344-9132
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
66904
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UNKNOWN
UNKNOWN
TX
Enumeration date
04/22/2022
Last updated
04/22/2022
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