Provider Demographics
NPI:1295834851
Name:O'HARA, PAUL JUDE (MA, LP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JUDE
Last Name:O'HARA
Suffix:
Gender:M
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 FRANCE AVE S
Mailing Address - Street 2:#560
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2007
Mailing Address - Country:US
Mailing Address - Phone:651-246-1912
Mailing Address - Fax:
Practice Address - Street 1:6800 FRANCE AVE S
Practice Address - Street 2:#560
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2007
Practice Address - Country:US
Practice Address - Phone:651-246-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3038103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist