Provider Demographics
NPI:1073839791
Name:OROURKE, JOHN CHARLES (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:OROURKE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 E DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4538
Mailing Address - Country:US
Mailing Address - Phone:816-390-8813
Mailing Address - Fax:
Practice Address - Street 1:2404 HIGHLY ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2729
Practice Address - Country:US
Practice Address - Phone:816-646-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100109541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical