Provider Demographics
NPI:1821817214
Name:MCNIEL, JAHNEYIS LEBRANDY-SUE
Entity type:Individual
Prefix:
First Name:JAHNEYIS
Middle Name:LEBRANDY-SUE
Last Name:MCNIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 FRANKLIN BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2982
Mailing Address - Country:US
Mailing Address - Phone:510-216-9150
Mailing Address - Fax:
Practice Address - Street 1:7360 FRANKLIN BLVD APT 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2982
Practice Address - Country:US
Practice Address - Phone:510-216-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician