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General NPI Number Information
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NPI Number | 1215141288
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Entity Type | Individual
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Provider Name | LAURA B. O'CONNOR PSY. D., MFT, BCBA
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Gender | Female
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 4640 S MACADAM AVE STE 90
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City | PORTLAND
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State | OR
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Zip | 97239-4285
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Country | US
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Telephone | 503-292-0765
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Fax |
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Provider Business Mailing Address
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Address Line | 4640 S MACADAM AVE STE 90
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City | PORTLAND
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State | OR
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Zip | 97239-4285
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Country | US
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Telephone | 310-883-5431
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3371
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 44226
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | MFC 44226
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 29491
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License Number State | CA
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