Provider Demographics
NPI:1427145499
Name:MCNEAL, DAVID G (MS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:MCNEAL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 S COUNTRY SQUIRE RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1227
Mailing Address - Country:US
Mailing Address - Phone:708-448-7540
Mailing Address - Fax:
Practice Address - Street 1:66 S COUNTRY SQUIRE RD
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1227
Practice Address - Country:US
Practice Address - Phone:708-785-5036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL18081OtherVMC BEHAVIORAL HEALTHCARE
IL14659167OtherUBH
IL167001OtherCOMPSYCH
IL189987OtherMHN
IL339000OtherPSYCHEALTH
IL1632506OtherBCBSIL
IL155607OtherVALUE OPTIONS