Doctor Name: | MS. JACKIE ANN MCNEILL |
NPI Number: | 1023216967 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 2884 |
Business Practice Address: | 2223 Main Ave Suite 102 Durango, CO - 813014654 |
Business Phone Number: | 9707991547 |
Business Fax Number: | |
Mailing Address: | 101 W 9th St, Unit 8 DURANGO |
State: | CO |
Postal Code: | 813015489 |
Phone Number: | 9707991547 |
Fax Number: | |
NPI Enumeration Date: | 07/03/2007 |
NPI Last Update Date: | 12/07/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2884 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |