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General NPI Number Information
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NPI Number | 1699936948
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Entity Type | Organization
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Legal Business Name | O'NEILL PSYCHOLOGICAL SERVICES INC
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 365 118TH AVE SE SUITE 118
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City | BELLEVUE
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State | WA
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Zip | 98005
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Country | US
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Telephone | 206-351-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 210 E BLAINE ST #309
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City | SEATTLE
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State | WA
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Zip | 98102
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Country | US
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Telephone | 206-351-1100
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | BETHANY ANN O'NEILL
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Credential | PSY.D
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Telephone | 203-351-1100
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY60234792
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License Number State | WA
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