Provider Demographics
NPI:1891842225
Name:MCANALLY, TONY D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:D
Last Name:MCANALLY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 CRESTHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3833
Mailing Address - Country:US
Mailing Address - Phone:901-763-4357
Mailing Address - Fax:901-767-4728
Practice Address - Street 1:1037 CRESTHAVEN RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3833
Practice Address - Country:US
Practice Address - Phone:901-763-4357
Practice Address - Fax:901-767-4728
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000042471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4033634OtherBLUECROSS BLUESHIELD