Healthcare Provider Details

I. General information

NPI: 1598749780
Provider Name (Legal Business Name): DANIEL ERIC MCNEELY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S ROGERS ST
BLOOMINGTON IN
47403-2353
US

IV. Provider business mailing address

645 S ROGERS ST
BLOOMINGTON IN
47403-2353
US

V. Phone/Fax

Practice location:
  • Phone: 812-339-1691
  • Fax: 812-339-8109
Mailing address:
  • Phone: 812-339-1691
  • Fax: 812-339-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003338A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34003338A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: