Provider Demographics
NPI:1679018006
Name:O'NEAL, MARK CONAL
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CONAL
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 JACKSON ST APT 812
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-5218
Mailing Address - Country:US
Mailing Address - Phone:214-475-3712
Mailing Address - Fax:469-206-0504
Practice Address - Street 1:1122 JACKSON ST APT 812
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75202-5218
Practice Address - Country:US
Practice Address - Phone:214-475-3712
Practice Address - Fax:469-206-0504
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72166101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional