Healthcare Provider Details

I. General information

NPI: 1649647280
Provider Name (Legal Business Name): MEHGAN MCNEIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 COIT AVE NE
GRAND RAPIDS MI
49505-4753
US

IV. Provider business mailing address

1932 COIT AVE NE
GRAND RAPIDS MI
49505-4753
US

V. Phone/Fax

Practice location:
  • Phone: 616-262-8548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA9940
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401015308
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: