Provider Demographics
NPI:1588017206
Name:MCGINNIS, MICHAEL FRANCIS (LADC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:MN
Mailing Address - Zip Code:56098-0316
Mailing Address - Country:US
Mailing Address - Phone:507-893-4663
Mailing Address - Fax:
Practice Address - Street 1:12 CIVIC CENTER PLZ STE 2116
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7789
Practice Address - Country:US
Practice Address - Phone:507-381-3483
Practice Address - Fax:507-381-1895
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301388101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)