Provider Demographics
NPI:1871135590
Name:MCKAY, SADIE (PCLC)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:
Last Name:MCKAY
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9385 MORMON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-9561
Mailing Address - Country:US
Mailing Address - Phone:509-638-7522
Mailing Address - Fax:
Practice Address - Street 1:9385 MORMON CREEK RD
Practice Address - Street 2:
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847-9561
Practice Address - Country:US
Practice Address - Phone:509-638-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60774893101YM0800X
MTBBH-PCLC-LIC-55385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health