Healthcare Provider Details

I. General information

NPI: 1295381804
Provider Name (Legal Business Name): TIMOTHY MCNEILL LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TIM MCNEILL

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E BEAUMONT AVE APT B
GREENVILLE IL
62246-1262
US

IV. Provider business mailing address

525 E BEAUMONT AVE APT B
GREENVILLE IL
62246-1262
US

V. Phone/Fax

Practice location:
  • Phone: 510-847-3386
  • Fax:
Mailing address:
  • Phone: 510-847-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61028886
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178020880
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: