Provider Demographics
NPI:1346819877
Name:OSHEA, CONNOR KYLE
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:KYLE
Last Name:OSHEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 W JEFFERSON AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2373
Mailing Address - Country:US
Mailing Address - Phone:303-918-0962
Mailing Address - Fax:
Practice Address - Street 1:7114 W JEFFERSON AVE STE 306
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2373
Practice Address - Country:US
Practice Address - Phone:303-918-0962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-19
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11251992Medicaid