Provider Demographics
NPI:1841287117
Name:O'CONNOR, COLLEEN J (MS LAC NCAC II)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:J
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MS LAC NCAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-2216
Mailing Address - Country:US
Mailing Address - Phone:406-248-5558
Mailing Address - Fax:406-245-0547
Practice Address - Street 1:2320 3RD AVE N
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-2216
Practice Address - Country:US
Practice Address - Phone:406-248-5558
Practice Address - Fax:406-245-0547
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT857101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT760340OtherBCBS BILLINGS
MT760350OtherBCBS COLUMBUS
MT760360OtherBCBS BIG TIMBER