Provider Demographics
NPI:1164541827
Name:O'NEILL, CHRISTINE LEE (MS)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LEE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:LEE
Other - Last Name:DECREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1008 NORTHERN WAY
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8178
Mailing Address - Country:US
Mailing Address - Phone:303-378-6668
Mailing Address - Fax:
Practice Address - Street 1:3180 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2208
Practice Address - Country:US
Practice Address - Phone:303-957-6293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO618101YA0400X
CO5563101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1164541827Medicaid