Provider Demographics
NPI:1609631274
Name:MCKINNEY, LUCIAN JEROME III
Entity type:Individual
Prefix:
First Name:LUCIAN
Middle Name:JEROME
Last Name:MCKINNEY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7755 SUN HILL DR APT 254
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-5958
Mailing Address - Country:US
Mailing Address - Phone:916-937-4103
Mailing Address - Fax:
Practice Address - Street 1:1540 EUREKA RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3056
Practice Address - Country:US
Practice Address - Phone:916-207-9255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program