Healthcare Provider Details

I. General information

NPI: 1447011945
Provider Name (Legal Business Name): MARY OCONNOR LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11512 W 183RD ST SE
ORLAND PARK IL
60467
US

IV. Provider business mailing address

522 MCGREGOR ST
BLOOMINGTON IL
61701-5610
US

V. Phone/Fax

Practice location:
  • Phone: 630-294-0288
  • Fax:
Mailing address:
  • Phone: 815-822-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.018078
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: