MEDICARE: DR. CASEY O'NEAL PH.D.

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	103T00000X	Psychologist	33694	TX
2	103T00000X	Psychologist	PY60253699	WA
3	103TS0200X	School Psychologist	35228	TX

General Provider Information

NPI Number	:	1700266632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASEY O'NEAL PH.D.

Provider Business Mailing Address
First Line	:	595 ROUND ROCK WEST DR STE 104
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5028
Country	:	US
Telephone Number	:	512-294-5444
Fax Number	:

Provider Business Practice Location Address
First Line	:	595 ROUND ROCK WEST DR STE 104
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5028
Country	:	US
Telephone Number	:	512-294-5444
Fax Number	:

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

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	06/05/2015

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