Healthcare Provider Details

I. General information

NPI: 1841237609
Provider Name (Legal Business Name): MICHAEL A O'CONNELL PHD, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 MILL CREEK BLVD 202
MILL CREEK WA
98012-1737
US

IV. Provider business mailing address

16300 MILL CREEK BLVD 202
MILL CREEK WA
98012-1737
US

V. Phone/Fax

Practice location:
  • Phone: 425-741-1405
  • Fax: 425-745-5865
Mailing address:
  • Phone: 425-741-1405
  • Fax: 425-745-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00004619
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: