Basic Information
| Provider Information | |||||||||
| NPI: | 1558548065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCONIHAY | ||||||||
| FirstName: | JEFFREY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3851 ROGER BROOKE DR | ||||||||
| Address2: | |||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109162460 | ||||||||
| FaxNumber: | 2109165102 | ||||||||
| Practice Location | |||||||||
| Address1: | LRMC BUILDING 3757, WARD 2C | ||||||||
| Address2: | |||||||||
| City: | LANDSTUHL | ||||||||
| State: | RHEINLAND-PLATZ | ||||||||
| PostalCode: | 66849 | ||||||||
| CountryCode: | DE | ||||||||
| TelephoneNumber: | 3145908040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2008 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103TC0700X | 1512 | AL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.