Provider Demographics
NPI:1518390798
Name:O'NEAL, KATHERINE MARIE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:KINGDOM CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65262-0059
Mailing Address - Country:US
Mailing Address - Phone:573-642-5345
Mailing Address - Fax:573-642-5162
Practice Address - Street 1:8548 JADE RD
Practice Address - Street 2:
Practice Address - City:KINGDOM CITY
Practice Address - State:MO
Practice Address - Zip Code:65262
Practice Address - Country:US
Practice Address - Phone:573-642-5345
Practice Address - Fax:573-642-5162
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013011420101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor