Provider Demographics
NPI:1124164553
Name:O'NEIL, JOHN NOLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NOLEN
Last Name:O'NEIL
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 1:7101 YORK AVE S STE 301
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4469
Mailing Address - Country:US
Mailing Address - Phone:612-223-7103
Mailing Address - Fax:952-681-2792
Practice Address - Street 1:7101 YORK AVE S STE 301
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4469
Practice Address - Country:US
Practice Address - Phone:612-223-7103
Practice Address - Fax:952-681-2792
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2019-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP40630OtherHEALTH PARTNERS
MN013764200Medicaid
6169449OtherMEDICA
MN169041OtherUCARE
MN49F690NOtherBLUE CROSS BLUE SHIELD
MN680001421Medicare ID - Type Unspecified