Provider Demographics
NPI:1578830071
Name:MCNEIL, JACKLYN ANN (MDIV, MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:JACKLYN
Middle Name:ANN
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:MDIV, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 SW 112TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7652
Mailing Address - Country:US
Mailing Address - Phone:806-670-9459
Mailing Address - Fax:
Practice Address - Street 1:4300 ALICIA DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5052
Practice Address - Country:US
Practice Address - Phone:806-670-9459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63099101YP2500X
OK5500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional