Provider Demographics
NPI:1760923247
Name:SMITH-MCNEAL, WILLYMAE (LMHC)
Entity Type:Individual
Prefix:
First Name:WILLYMAE
Middle Name:
Last Name:SMITH-MCNEAL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CARRIZO TRL
Mailing Address - Street 2:
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340-9766
Mailing Address - Country:US
Mailing Address - Phone:575-464-4433
Mailing Address - Fax:575-464-4331
Practice Address - Street 1:107 SUNSET LOOP
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340-0228
Practice Address - Country:US
Practice Address - Phone:575-464-4433
Practice Address - Fax:575-464-4331
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2019-01-22
Deactivation Date:2019-01-07
Deactivation Code:
Reactivation Date:2019-01-22
Provider Licenses
StateLicense IDTaxonomies
NMT0184841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health