Healthcare Provider Details

I. General information

NPI: 1669032306
Provider Name (Legal Business Name): SEAN MCNALLY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 S GILBERT RD STE 1-246
CHANDLER AZ
85249-5982
US

IV. Provider business mailing address

4960 S GILBERT RD STE 1-246
CHANDLER AZ
85249-5982
US

V. Phone/Fax

Practice location:
  • Phone: 480-770-6628
  • Fax:
Mailing address:
  • Phone: 480-770-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-18084
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: