Provider Demographics
NPI:1548227150
Name:MCKINNEY BOTEFUHR, DAWN CHAREE (MED, LPC-S, NCC)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:CHAREE
Last Name:MCKINNEY BOTEFUHR
Suffix:
Gender:F
Credentials:MED, LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 LARRY CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-2823
Mailing Address - Country:US
Mailing Address - Phone:903-454-7404
Mailing Address - Fax:
Practice Address - Street 1:8500 LARRY CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-2823
Practice Address - Country:US
Practice Address - Phone:903-454-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095659104Medicaid
TX10042808OtherAMERIGROUP
TX458035OtherVALUE OPTIONS
TX7724855OtherAETNA
TX458035OtherNORTHSTAR
TX07246LCOtherBCBS
TX11604965OtherCAQH