Provider Demographics
NPI:1174359269
Name:O'NEIL, KATIE (LPC-IT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 STRUCK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1383
Mailing Address - Country:US
Mailing Address - Phone:303-974-0347
Mailing Address - Fax:
Practice Address - Street 1:639 STRUCK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1383
Practice Address - Country:US
Practice Address - Phone:608-234-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8103226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health