Provider Demographics
NPI:1457868770
Name:O'NEILL, MELISSA SUE (LMHC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 N OCEAN BLVD APT 325
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1965
Mailing Address - Country:US
Mailing Address - Phone:954-955-8084
Mailing Address - Fax:
Practice Address - Street 1:2409 N OCEAN BLVD APT 325
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33305-1965
Practice Address - Country:US
Practice Address - Phone:954-955-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15224101YM0800X
FLMH16396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health