Provider Demographics
NPI:1780203281
Name:O'NEILL, IAN
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:O'NEILL
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 1:2227 234TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-4407
Mailing Address - Country:US
Mailing Address - Phone:425-979-1577
Mailing Address - Fax:
Practice Address - Street 1:2227 234TH AVE NE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-4407
Practice Address - Country:US
Practice Address - Phone:425-979-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health