Provider Demographics
NPI:1255642740
Name:O'CONNELL, PATRICK ALLEN (MA, LMHC)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:ALLEN
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-1734
Mailing Address - Country:US
Mailing Address - Phone:574-936-3377
Mailing Address - Fax:574-936-3910
Practice Address - Street 1:322 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1734
Practice Address - Country:US
Practice Address - Phone:574-936-3377
Practice Address - Fax:574-936-3910
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002253A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200400060Medicaid