MEDICARE: MALLORY O'NEAL LMFT

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	106H00000X	Marriage & Family Therapist	201714	TX

General Provider Information

NPI Number	:	1558722801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY O'NEAL LMFT

Provider Business Mailing Address
First Line	:	11300 N CENTRAL EXPY
Second Line	:	SUITE 610
City	:	DALLAS
State	:	TX
Zip	:	75243-6717
Country	:	US
Telephone Number	:	214-530-0021
Fax Number	:	214-530-0021

Provider Business Practice Location Address
First Line	:	11300 N CENTRAL EXPY
Second Line	:	SUITE 610
City	:	DALLAS
State	:	TX
Zip	:	75243-6717
Country	:	US
Telephone Number	:	214-530-0021
Fax Number	:	214-530-0021

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

Provider Enumeration Date	:	03/15/2016
Last Update Date	:	03/15/2016

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