Provider Demographics
NPI:1003691007
Name:O'CONNELL, TARA THERESA (LCSW-S)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:THERESA
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 TOPEKA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2436
Mailing Address - Country:US
Mailing Address - Phone:361-563-8986
Mailing Address - Fax:
Practice Address - Street 1:3129 TOPEKA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2436
Practice Address - Country:US
Practice Address - Phone:361-563-8986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX419451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical