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General NPI Number Information
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NPI Number | 1235291469
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Entity Type | Individual
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Provider Name | KEVIN ROBERT O'CONNOR M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 965 E YOSEMITE AVE SUITE # 12
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City | MANTECA
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State | CA
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Zip | 95336-5938
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Country | US
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Telephone | 209-404-0196
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Fax |
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Provider Business Mailing Address
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Address Line | 515 MEADOWLAND DR
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City | RIPON
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State | CA
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Zip | 95366-9512
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Country | US
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Telephone | 209-599-5535
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Fax | 209-599-5535
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC41168
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License Number State | CA
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