1245472372 NPI number — MISS MICHELE LEE O'CONNELL LPC

Table of content: MISS MICHELE LEE O'CONNELL LPC (NPI 1245472372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245472372 NPI number — MISS MICHELE LEE O'CONNELL LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'CONNELL
Provider First Name:
MICHELE
Provider Middle Name:
LEE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245472372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 WALNUT BOTTOM RD
Provider Second Line Business Mailing Address:
SUITE 311
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17015-7766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-243-1511
Provider Business Mailing Address Fax Number:
717-243-1530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 WALNUT BOTTOM RD
Provider Second Line Business Practice Location Address:
SUITE 311
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17015-7766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-243-1511
Provider Business Practice Location Address Fax Number:
717-243-1530
Provider Enumeration Date:
04/06/2009

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:  PC005099 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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