MEDICARE: LORELEI O'NEILL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1548613920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORELEI O'NEILL

Provider Business Mailing Address
First Line	:	PO BOX 10742
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92658-5006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23181 LA CADENA DR
Second Line	:	SUITE 104
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1479
Country	:	US
Telephone Number	:	949-478-2922
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	07/20/2016

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