Provider Demographics
NPI:1598422388
Name:O'NEILL, TERRENCE MICHAEL (IMH)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:MICHAEL
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:IMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 BEDFORD G
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-2243
Mailing Address - Country:US
Mailing Address - Phone:561-301-2428
Mailing Address - Fax:
Practice Address - Street 1:2465 MERCER AVE STE 204
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7449
Practice Address - Country:US
Practice Address - Phone:561-301-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH16165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty