Healthcare Provider Details

I. General information

NPI: 1740410018
Provider Name (Legal Business Name): STEVEN J. MCNEILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 CERRILLOS RD
SANTA FE NM
87505-3373
US

IV. Provider business mailing address

2325 CERRILLOS RD
SANTA FE NM
87505-3373
US

V. Phone/Fax

Practice location:
  • Phone: 505-438-0010
  • Fax: 505-438-6011
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: