| Doctor Name: | GRADY O'NEILL |
| NPI Number: | 1245695899 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA |
| License Number: | |
| Business Practice Address: | E23970 Pow Wow Trail Watersmeet, MI - 49969 |
| Business Phone Number: | 9063580252 |
| Business Fax Number: | |
| Mailing Address: | Po Box 75, RAMSAY |
| State: | MI |
| Postal Code: | 499590075 |
| Phone Number: | 9063641138 |
| Fax Number: | |
| NPI Enumeration Date: | 12/28/2015 |
| NPI Last Update Date: | 12/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |