Provider Demographics
NPI:1235243064
Name:OCONNOR, JOHN BRIAN (MA LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BRIAN
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:MR
Other - First Name:J
Other - Middle Name:BRIAN
Other - Last Name:OCONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 460509
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78246-0509
Mailing Address - Country:US
Mailing Address - Phone:210-524-9402
Mailing Address - Fax:210-524-9732
Practice Address - Street 1:5410 FREDERICKSBURG ROAD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3539
Practice Address - Country:US
Practice Address - Phone:210-524-9402
Practice Address - Fax:210-524-9732
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3077LCOtherBLUE CROSS BLUE SHIELD