Provider Demographics
NPI:1295381804
Name:MCNEILL, TIMOTHY (LPC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MCNEILL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:MCNEILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:525 E BEAUMONT AVE APT B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1262
Mailing Address - Country:US
Mailing Address - Phone:510-847-3386
Mailing Address - Fax:
Practice Address - Street 1:525 E BEAUMONT AVE APT B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1262
Practice Address - Country:US
Practice Address - Phone:510-847-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-11
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61028886101YM0800X
IL178020880101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)