Provider Demographics
NPI:1922397355
Name:O'CONNOR, BAYLEA (MFT)
Entity Type:Individual
Prefix:
First Name:BAYLEA
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 7TH AVE UNIT 203
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7176
Mailing Address - Country:US
Mailing Address - Phone:619-667-4700
Mailing Address - Fax:
Practice Address - Street 1:325 7TH AVE UNIT 203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7176
Practice Address - Country:US
Practice Address - Phone:619-667-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist