1770001109 NPI number — KATHY O'CONNELL, LMFT, LLC

Table of content: (NPI 1770001109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770001109 NPI number — KATHY O'CONNELL, LMFT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHY O'CONNELL, LMFT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1770001109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
341 MULBERRY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROYERSFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19468-1272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-256-6022
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
373 E MAIN ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19426-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-256-6022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
O'CONNELL
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-256-6022

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MF000880 , 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)

  • Identifier: 08-3089734 . This is a "NPI-1" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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