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General NPI Number Information
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NPI Number | 1306921275
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Entity Type | Organization
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Legal Business Name | JOHN N. O'NEIL, PH.D., L.P., LLC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 825 NICOLLET MALL 1735 MEDICAL ARTS BUILDING
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City | MINNEAPOLIS
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State | MN
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Zip | 55402-2704
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Country | US
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Telephone | 612-455-6167
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Fax | 612-333-6740
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Provider Business Mailing Address
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Address Line | 825 NICOLLET MALL 1735 MEDICAL ARTS BUILDING
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City | MINNEAPOLIS
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State | MN
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Zip | 55402-2704
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Country | US
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Telephone | 612-455-6167
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Fax | 612-333-6740
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. JOHN NOLEN O'NEIL
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Credential | PH.D.
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Telephone | 612-455-6167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP4307
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License Number State | MN
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