Healthcare Provider Details

I. General information

NPI: 1255480240
Provider Name (Legal Business Name): MR. SEAN WILLIAM MCINNIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W COLUMBUS ST
BAKERSFIELD CA
93301-1263
US

IV. Provider business mailing address

1201 40TH ST APARTMENT 41
BAKERSFIELD CA
93301-1157
US

V. Phone/Fax

Practice location:
  • Phone: 661-328-0245
  • Fax: 661-631-0876
Mailing address:
  • Phone: 661-332-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: