Provider Demographics
NPI:1619326246
Name:MCGINNIS, DUSTIN
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:
Last Name:MCGINNIS
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 1:1215 WINDHORST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-3122
Mailing Address - Country:US
Mailing Address - Phone:813-514-5443
Mailing Address - Fax:
Practice Address - Street 1:1215 WINDHORST RIDGE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-3122
Practice Address - Country:US
Practice Address - Phone:813-514-5443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-04
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst