Provider Demographics
NPI:1902969983
Name:MCKINNIE, MICHELE CATHERINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:CATHERINE
Last Name:MCKINNIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1648 ELLIS ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8810
Mailing Address - Country:US
Mailing Address - Phone:406-582-1321
Mailing Address - Fax:406-587-1513
Practice Address - Street 1:1648 ELLIS ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8810
Practice Address - Country:US
Practice Address - Phone:406-582-1321
Practice Address - Fax:406-587-1513
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT52441OtherBCBS-MT PROVIDER NUMBER
MT0000492881Medicaid