Provider Demographics
NPI:1740873587
Name:MCNEIL, MISSY MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:MISSY
Middle Name:MARIE
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 AJIJAAK AVE
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8330
Mailing Address - Country:US
Mailing Address - Phone:231-242-1640
Mailing Address - Fax:
Practice Address - Street 1:1260 AJIJAAK AVE
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8330
Practice Address - Country:US
Practice Address - Phone:231-242-1640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011169021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical