Provider Demographics
NPI:1568580900
Name:O'NEAL, MICHAEL KELLY (LCDC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KELLY
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W BOYD DR
Mailing Address - Street 2:105D
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2582
Mailing Address - Country:US
Mailing Address - Phone:972-359-1600
Mailing Address - Fax:972-359-9558
Practice Address - Street 1:201 W BOYD DR
Practice Address - Street 2:105D
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2582
Practice Address - Country:US
Practice Address - Phone:972-359-1600
Practice Address - Fax:972-359-9558
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6720101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX561033OtherVALUE OPTIONS