Basic Information
Provider Information
NPI: 1366026957
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCMONIGLE
FirstName: JOEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 285 BIELBY RD
Address2:  
City: LAWRENCEBURG
State: IN
PostalCode: 470251055
CountryCode: US
TelephoneNumber: 8125371302
FaxNumber:  
Practice Location
Address1: 427 W EADS PARKWAY
Address2:  
City: LAWRENCEBURG
State: IN
PostalCode: 47025
CountryCode: US
TelephoneNumber: 8125377375
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/10/2021
LastUpdateDate: 05/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X INY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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