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General NPI Number Information
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NPI Number | 1902940133
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Entity Type | Organization
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Legal Business Name | MICHAEL F OCONNELL PHD
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 728 CARDLEY AVE
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City | MEDFORD
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State | OR
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Zip | 97504-6124
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Country | US
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Telephone | 541-773-4077
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Fax | 541-773-3621
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Provider Business Mailing Address
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Address Line | 728 CARDLEY AVE
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City | MEDFORD
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State | OR
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Zip | 97504-6124
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Country | US
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Telephone | 541-773-4077
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Fax | 541-773-3621
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL FRANCIS O'CONNELL
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Credential | PH. D.
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Telephone | 541-773-4077
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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 | 452
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License Number State | OR
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