Healthcare Provider Details

I. General information

NPI: 1427564939
Provider Name (Legal Business Name): HEATHER O'CONNELL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 N RIDGE RD E STE D
LORAIN OH
44055-3359
US

IV. Provider business mailing address

378 S MAIN ST APT 4
AMHERST OH
44001-2149
US

V. Phone/Fax

Practice location:
  • Phone: 440-324-5701
  • Fax:
Mailing address:
  • Phone: 440-225-4782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2102512
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1700555
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: