Provider Demographics
NPI:1669867016
Name:PATRICK O'CONNELL, LLC
Entity type:Organization
Organization Name:PATRICK O'CONNELL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:219-465-8794
Mailing Address - Street 1:2005 VALPARAISO ST
Mailing Address - Street 2:SUITE # 109
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3137
Mailing Address - Country:US
Mailing Address - Phone:219-465-8794
Mailing Address - Fax:219-299-2430
Practice Address - Street 1:2005 VALPARAISO ST
Practice Address - Street 2:SUITE # 109
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3137
Practice Address - Country:US
Practice Address - Phone:219-465-8794
Practice Address - Fax:219-299-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002253A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty