Provider Demographics
NPI:1659079879
Name:MCNALLY, COVA LYNN (RAC)
Entity Type:Individual
Prefix:MISS
First Name:COVA
Middle Name:LYNN
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13525 CIELO AZUL WAY
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-6235
Mailing Address - Country:US
Mailing Address - Phone:760-329-4673
Mailing Address - Fax:760-329-7311
Practice Address - Street 1:13525 CIELO AZUL WAY
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-6235
Practice Address - Country:US
Practice Address - Phone:760-329-4673
Practice Address - Fax:760-329-7311
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16286101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)