Provider Demographics
NPI:1790882454
Name:O'NEIL, TERRY S (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:S
Last Name:O'NEIL
Suffix:
Gender:F
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:PO BOX 52842
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98015-2842
Mailing Address - Country:US
Mailing Address - Phone:425-990-9840
Mailing Address - Fax:425-990-8899
Practice Address - Street 1:1800 112TH AVE NE
Practice Address - Street 2:SUITE 322E
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2938
Practice Address - Country:US
Practice Address - Phone:425-990-9840
Practice Address - Fax:425-990-8899
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8852013Medicare PIN