Provider Demographics
NPI:1881750545
Name:O'CONNOR, MARY KAY (MFT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAY
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 W KIMBERLY AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6343
Mailing Address - Country:US
Mailing Address - Phone:714-993-2237
Mailing Address - Fax:714-993-2241
Practice Address - Street 1:721 W KIMBERLY AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6343
Practice Address - Country:US
Practice Address - Phone:714-993-2237
Practice Address - Fax:714-993-2241
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health