Provider Demographics
NPI:1962086082
Name:OCONNOR, MATTHEW BRADY (LPC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:BRADY
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8727 LITZSINGER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2305
Mailing Address - Country:US
Mailing Address - Phone:314-795-8666
Mailing Address - Fax:
Practice Address - Street 1:8727 LITZSINGER DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-2305
Practice Address - Country:US
Practice Address - Phone:314-795-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012029822101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional