Provider Demographics
NPI:1215259742
Name:ONEILL, GAIL ELLEN (LMHC)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:ELLEN
Last Name:ONEILL
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 1:2525 AURORA RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2833
Mailing Address - Country:US
Mailing Address - Phone:321-622-6710
Mailing Address - Fax:
Practice Address - Street 1:2525 AURORA RD STE 104
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2833
Practice Address - Country:US
Practice Address - Phone:321-622-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0004695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health