Provider Demographics
NPI:1275099251
Name:O'NEILL, SAEWARD (LPC)
Entity Type:Individual
Prefix:
First Name:SAEWARD
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 NORTHSTAR DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2569
Mailing Address - Country:US
Mailing Address - Phone:208-406-2290
Mailing Address - Fax:
Practice Address - Street 1:210 W BURNSIDE AVE STE A
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83202-4916
Practice Address - Country:US
Practice Address - Phone:208-238-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7163101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health