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General NPI Number Information
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NPI Number | 1104575398
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Entity Type | Individual
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Provider Name | DR. ESSENCE O'NEAL
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Gender | Female
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1445 N HUNT CLUB RD
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City | GURNEE
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State | IL
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Zip | 60031-2655
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Country | US
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Telephone | 872-529-0362
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 653
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City | ZION
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State | IL
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Zip | 60099-0653
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.010611
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License Number State | IL
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