Healthcare Provider Details

I. General information

NPI: 1215141288
Provider Name (Legal Business Name): LAURA B. O'CONNOR PSY. D., MFT, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 S MACADAM AVE STE 90
PORTLAND OR
97239-4285
US

IV. Provider business mailing address

4640 S MACADAM AVE STE 90
PORTLAND OR
97239-4285
US

V. Phone/Fax

Practice location:
  • Phone: 503-292-0765
  • Fax:
Mailing address:
  • Phone: 310-883-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3371
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number44226
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMFC 44226
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number29491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: