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General NPI Number Information
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NPI Number | 1336002294
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Entity Type | Individual
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Provider Name | MARISA IEVANS O'CONNOR
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Gender | Female
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 3008 RM 2244 FLOOR 2
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City | ROLLINGWOOD
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State | TX
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Zip | 78746
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Country | US
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Telephone | 214-724-6471
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Fax |
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Provider Business Mailing Address
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Address Line | 7102 TOWERING OAKS DR
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City | AUSTIN
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State | TX
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Zip | 78745-5223
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Country | US
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Telephone | 312-882-7625
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 92927
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License Number State | TX
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