Provider Demographics
NPI:1407025455
Name:O'CONNOR, HEATHER MARIE (LMFT, LADC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 EAGLE CREEK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378
Mailing Address - Country:US
Mailing Address - Phone:952-746-7664
Mailing Address - Fax:952-746-0582
Practice Address - Street 1:8640 EAGLE CREEK CIRCLE
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378
Practice Address - Country:US
Practice Address - Phone:952-746-7664
Practice Address - Fax:952-746-0582
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2505106H00000X
MN301795101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN301795OtherLADC