Provider Demographics
NPI:1124312301
Name:MCNEIL, MICHAEL SCOTT (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:MCNEIL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-5602
Mailing Address - Country:US
Mailing Address - Phone:325-672-9999
Mailing Address - Fax:325-672-5237
Practice Address - Street 1:1502 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5602
Practice Address - Country:US
Practice Address - Phone:325-672-9999
Practice Address - Fax:325-672-5237
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30810103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX277162YQLYOtherMEDICARE PTAN
TX286884604Medicaid