Provider Demographics
NPI:1760549828
Name:O'CONNOR, BRIAN DANIEL (MA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DANIEL
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 POINT FOSDICK DR NW
Mailing Address - Street 2:STE. 302
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-851-3808
Mailing Address - Fax:253-851-3188
Practice Address - Street 1:4700 POINT FOSDICK DR NW
Practice Address - Street 2:STE. 302
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-851-3808
Practice Address - Fax:253-851-3188
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health