MEDICARE: MR. CURTIS JUNIOR MCNIEL JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1659114494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CURTIS JUNIOR MCNIEL JR.

Provider Business Mailing Address
First Line	:	1709 CANYON RD
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-3934
Country	:	US
Telephone Number	:	619-646-4619
Fax Number	:

Provider Business Practice Location Address
First Line	:	1709 CANYON RD
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-3934
Country	:	US
Telephone Number	:	619-779-9931
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	06/18/2024

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