Provider Demographics
NPI:1891168050
Name:OCONNOR, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 QUAIL RDG
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3228
Mailing Address - Country:US
Mailing Address - Phone:405-481-9411
Mailing Address - Fax:405-481-9411
Practice Address - Street 1:9 QUAIL RDG
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-3228
Practice Address - Country:US
Practice Address - Phone:405-481-9411
Practice Address - Fax:405-481-9411
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)