Provider Information for 1114431764
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KYLA SHANEEK O'NEAL LCPC
Sex: Female
NPI: 1114431764
Last Updated: 2019-03-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1114431764 | ||||||||
| Enumeration Date | 2017-11-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 22923 VALLEY DR RICHTON PARK, IL 60471-2338 United States Phone: 708-639-0763 | Fax: | ||||||||
| Primary Practice Address | 935 175TH ST STE 300 HOMEWOOD, IL 60430 United States Phone: 414-885-5193 | Fax: | ||||||||
| Secondary Practice Address(es) | 405 W 35TH ST APT 304 935 175TH ST STE 300 935 175TH ST STE 300 | ||||||||
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