Provider Demographics
NPI:1821217118
Name:MCCONNELL, HOWARD KEITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:KEITH
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 TREEHILL LOOP
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3553
Mailing Address - Country:US
Mailing Address - Phone:541-485-0772
Mailing Address - Fax:
Practice Address - Street 1:411 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2060
Practice Address - Country:US
Practice Address - Phone:541-942-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1717103T00000X, 103TC1900X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports