Provider Demographics
NPI:1679283923
Name:OCONNOR, GRACE MICHELLE (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:MICHELLE
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S RAMPART BLVD APT 214
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2624
Mailing Address - Country:US
Mailing Address - Phone:323-385-3428
Mailing Address - Fax:
Practice Address - Street 1:501 S RAMPART BLVD APT 214
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2624
Practice Address - Country:US
Practice Address - Phone:323-385-3428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128074106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist