Provider Demographics
NPI:1518957455
Name:MCMANN, NEAL R (EDD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:R
Last Name:MCMANN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 S PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552-5376
Mailing Address - Country:US
Mailing Address - Phone:928-428-7161
Mailing Address - Fax:928-428-7161
Practice Address - Street 1:104 S BROAD ST
Practice Address - Street 2:SUITE 5
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2643
Practice Address - Country:US
Practice Address - Phone:928-425-0366
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2557101YP1600X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ714156Medicare ID - Type Unspecified