Provider Demographics
NPI:1962505974
Name:MCNEELY, THOMAS KEITH (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:KEITH
Last Name:MCNEELY
Suffix:
Gender:M
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-4500
Mailing Address - Country:US
Mailing Address - Phone:507-931-8040
Mailing Address - Fax:507-931-8060
Practice Address - Street 1:1306 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-4500
Practice Address - Country:US
Practice Address - Phone:507-931-8040
Practice Address - Fax:507-931-8060
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20050036641041C0700X
MO20050036641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
943071044498OtherPREFERRED ONE
MA083408400Medicaid
276P7MCOtherBCBS
MA083408400Medicaid