Provider Demographics
NPI:1427815695
Name:MCNEAL, JUSTIN MICHAEL (ED)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MICHAEL
Last Name:MCNEAL
Suffix:
Gender:M
Credentials:ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7533 SUNWOOD DR NW STE 220
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-5195
Mailing Address - Country:US
Mailing Address - Phone:763-252-6570
Mailing Address - Fax:
Practice Address - Street 1:7533 SUNWOOD DR NW STE 220
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-5195
Practice Address - Country:US
Practice Address - Phone:763-252-6570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor