Provider Demographics
NPI:1558722801
Name:O'NEAL, MALLORY (LMFT)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 610
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6717
Mailing Address - Country:US
Mailing Address - Phone:214-530-0021
Mailing Address - Fax:214-530-0021
Practice Address - Street 1:11300 N CENTRAL EXPY
Practice Address - Street 2:SUITE 610
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6717
Practice Address - Country:US
Practice Address - Phone:214-530-0021
Practice Address - Fax:214-530-0021
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201714106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist