Provider Demographics
NPI:1871681981
Name:O'NEILL, BETHANY ANN (PSYD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E BLAINE ST.
Mailing Address - Street 2:APARTMENT #309
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102
Mailing Address - Country:US
Mailing Address - Phone:417-766-7008
Mailing Address - Fax:
Practice Address - Street 1:365 118TH STREET SE
Practice Address - Street 2:#118
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:206-381-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050389109103T00000X
WAPY60234792103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist