Provider Demographics
NPI:1457483984
Name:O'CONNOR, KATHLEEN RAE (EDD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:RAE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:EDD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12309 15TH AVE NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4864
Mailing Address - Country:US
Mailing Address - Phone:206-227-1826
Mailing Address - Fax:
Practice Address - Street 1:12309 15TH AVE NE
Practice Address - Street 2:SUITE D
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4864
Practice Address - Country:US
Practice Address - Phone:206-227-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health