Provider Demographics
NPI:1154773307
Name:MCNEILL, REGINALD
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:MCNEILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12915 SOUTHERN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3791
Mailing Address - Country:US
Mailing Address - Phone:713-806-6317
Mailing Address - Fax:
Practice Address - Street 1:9250 KIRBY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2500
Practice Address - Country:US
Practice Address - Phone:713-806-6317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58238104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker