Provider Demographics
NPI:1265105845
Name:MCNEELY, TOM
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:MCNEELY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 N GRAY ST
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-5245
Mailing Address - Country:US
Mailing Address - Phone:419-618-1135
Mailing Address - Fax:
Practice Address - Street 1:316 N GRAY ST
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-5245
Practice Address - Country:US
Practice Address - Phone:419-618-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty