Provider Demographics
NPI:1255480240
Name:MCINNIS, SEAN WILLIAM
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:WILLIAM
Last Name:MCINNIS
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 1:1201 40TH ST
Mailing Address - Street 2:APARTMENT 41
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1157
Mailing Address - Country:US
Mailing Address - Phone:661-332-3346
Mailing Address - Fax:
Practice Address - Street 1:501 W COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1263
Practice Address - Country:US
Practice Address - Phone:661-328-0245
Practice Address - Fax:661-631-0876
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)