Provider Demographics
NPI:1255523783
Name:TIMOTHY J. MCNEISH, PH. D. LLC
Entity type:Organization
Organization Name:TIMOTHY J. MCNEISH, PH. D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCNEISH
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:740-587-4434
Mailing Address - Street 1:1951 NEWARK GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9170
Mailing Address - Country:US
Mailing Address - Phone:740-587-4434
Mailing Address - Fax:740-587-1362
Practice Address - Street 1:1951 NEWARK GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9170
Practice Address - Country:US
Practice Address - Phone:740-587-4434
Practice Address - Fax:740-587-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9357451Medicare PIN