Provider Demographics
NPI:1972527604
Name:MCNALLY, STEPHEN MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:MCNALLY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:MICHAEL
Other - Last Name:MCNALLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:20073 COMMISSION RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-2659
Mailing Address - Country:US
Mailing Address - Phone:228-863-1586
Mailing Address - Fax:228-523-4754
Practice Address - Street 1:400 VETERANS AVE
Practice Address - Street 2:(116B)
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5804
Practice Address - Fax:228-523-4754
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS28 404103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling