1235243064 NPI number — MR. JOHN BRIAN OCONNOR MA LPC

Table of content: MR. JOHN BRIAN OCONNOR MA LPC (NPI 1235243064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235243064 NPI number — MR. JOHN BRIAN OCONNOR MA LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OCONNOR
Provider First Name:
JOHN
Provider Middle Name:
BRIAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OCONNOR
Provider Other First Name:
J
Provider Other Middle Name:
BRIAN
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235243064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 460509
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78246-0509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-524-9402
Provider Business Mailing Address Fax Number:
210-524-9732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5410 FREDERICKSBURG ROAD
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-524-9402
Provider Business Practice Location Address Fax Number:
210-524-9732
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  11061 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3077LC . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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