Provider Demographics
NPI:1548932106
Name:ONEIL, ADAM (PHD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ONEIL
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 1:2500 30TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1258
Mailing Address - Country:US
Mailing Address - Phone:310-945-8133
Mailing Address - Fax:
Practice Address - Street 1:2500 30TH ST STE 206
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1258
Practice Address - Country:US
Practice Address - Phone:310-945-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
462103TE1100X
CO5457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports