Provider Demographics
NPI:1720163272
Name:MCNEIL, STANLEY CHARLES (PSYD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:CHARLES
Last Name:MCNEIL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PRINCETON AVE.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2554
Mailing Address - Country:US
Mailing Address - Phone:503-657-4558
Mailing Address - Fax:503-656-4618
Practice Address - Street 1:250 PRINCETON AVE.
Practice Address - Street 2:SUITE 203
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2554
Practice Address - Country:US
Practice Address - Phone:503-657-4558
Practice Address - Fax:503-656-4618
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1378103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical