Provider Demographics
NPI:1295881829
Name:O'CONNOR, MICHAEL JOSEPH (LCDC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2069 SAKO DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-3224
Mailing Address - Country:US
Mailing Address - Phone:972-517-7375
Mailing Address - Fax:
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2420
Practice Address - Country:US
Practice Address - Phone:972-969-2470
Practice Address - Fax:972-969-2475
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1336101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)