Healthcare Provider Details

I. General information

NPI: 1306147269
Provider Name (Legal Business Name): DONIELLE O'CONNOR M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 ROOSEVELT WAY NE CENTER FOR PAIN RELIEF
SEATTLE WA
98105-6099
US

IV. Provider business mailing address

4225 ROOSEVELT WAY NE CENTER FOR PAIN RELIEF
SEATTLE WA
98105-6099
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-1716
  • Fax:
Mailing address:
  • Phone: 206-598-1716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberMC60165733
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: