Provider Demographics
NPI:1114254299
Name:OCONNELL, PATRICIA WELLS (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:WELLS
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 LANSING AVE STE 672
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2193
Mailing Address - Country:US
Mailing Address - Phone:517-788-4364
Mailing Address - Fax:517-780-4739
Practice Address - Street 1:1715 LANSING AVE STE 672
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2193
Practice Address - Country:US
Practice Address - Phone:517-788-4364
Practice Address - Fax:517-780-4739
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801021081101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor