Provider Demographics
NPI:1265174411
Name:O'CONNOR, KATHLEEN (LCPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 W CORTEZ ST APT 2W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4049
Mailing Address - Country:US
Mailing Address - Phone:815-768-5255
Mailing Address - Fax:
Practice Address - Street 1:2152 W CORTEZ ST APT 2W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4049
Practice Address - Country:US
Practice Address - Phone:815-768-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012174101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health