Provider Demographics
NPI:1871211094
Name:O'NEAL, TAMARA J (LCSW)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:J
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 E TWOHIG AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6433
Mailing Address - Country:US
Mailing Address - Phone:325-944-2561
Mailing Address - Fax:325-653-4218
Practice Address - Street 1:36 E TWOHIG AVE STE 600
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6433
Practice Address - Country:US
Practice Address - Phone:325-944-2561
Practice Address - Fax:325-653-4218
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX624491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX62449OtherLICENSE