Individual
LISA M MCKINNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1101 BALL AVE NE, GRAND RAPIDS, MI 49505-5904
(616) 456-7775
Mailing address
1101 BALL AVE NE, GRAND RAPIDS, MI 49505-5904
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401011001
MI
Other
Enumeration date
02/11/2011
Last updated
02/11/2011
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