Provider Demographics
NPI:1134505779
Name:MCDONNELL, BILL
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:
Last Name:MCDONNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 BLANKENSHIP AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2231
Mailing Address - Country:US
Mailing Address - Phone:702-945-3105
Mailing Address - Fax:
Practice Address - Street 1:1037 BLANKENSHIP AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2231
Practice Address - Country:US
Practice Address - Phone:702-945-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor