Provider Demographics
NPI:1689839557
Name:ONEAL, BRENT JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JOSEPH
Last Name:ONEAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 EASTLAKE AVE E STE 322
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3399
Mailing Address - Country:US
Mailing Address - Phone:206-931-6676
Mailing Address - Fax:
Practice Address - Street 1:2366 EASTLAKE AVE E STE 322
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3399
Practice Address - Country:US
Practice Address - Phone:206-931-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003864103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist