Healthcare Provider Details

I. General information

NPI: 1124830526
Provider Name (Legal Business Name): DANIEL JAMES KEEGAN O'CONNELL LCSW INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 ARNDT RD NE
AURORA OR
97002-8613
US

IV. Provider business mailing address

10921 ARNDT RD NE
AURORA OR
97002-8613
US

V. Phone/Fax

Practice location:
  • Phone: 310-745-0963
  • Fax:
Mailing address:
  • Phone: 310-745-0963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL JAMES KEEGAN O'CONNELL
Title or Position: OWNER / PRESIDENT
Credential: LCSW
Phone: 310-745-0963