Provider Demographics
NPI:1194795369
Name:O'NEILL, GEORGE W (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:O'NEILL
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 1:1401 13TH AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3468
Mailing Address - Country:US
Mailing Address - Phone:701-364-0060
Mailing Address - Fax:701-364-0065
Practice Address - Street 1:1401 13TH AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3468
Practice Address - Country:US
Practice Address - Phone:701-364-0060
Practice Address - Fax:701-364-0065
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND96103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21783OtherBLUECROSS/SHIELD-NO DAK
ND16974Medicaid
61-77285OtherMEDICA (UBH)
MN284S8ONOtherBLUECROSS/SHIELD-MINNESOT
475441026989OtherPREFERRED ONE
HP22980OtherHEALTHPARTNERS
R02208Medicare UPIN
NDN21783Medicare PIN