Healthcare Provider Details

I. General information

NPI: 1962557488
Provider Name (Legal Business Name): PHYLLIS O'NEILL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1679 WILLAMETTE ST
EUGENE OR
97401-4013
US

IV. Provider business mailing address

1679 WILLAMETTE ST
EUGENE OR
97401-4013
US

V. Phone/Fax

Practice location:
  • Phone: 541-510-2739
  • Fax:
Mailing address:
  • Phone: 541-510-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3870
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: