MEDICARE: KELLY O'CONNOR LMHC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH70042266	WA

General Provider Information

NPI Number	:	1346924180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY O'CONNOR LMHC, NCC

Provider Business Mailing Address
First Line	:	6226 213TH AVENUE CT E
Second Line	:
City	:	LAKE TAPPS
State	:	WA
Zip	:	98391-6134
Country	:	US
Telephone Number	:	253-455-0931
Fax Number	:

Provider Business Practice Location Address
First Line	:	6226 213TH AVENUE CT E
Second Line	:
City	:	LAKE TAPPS
State	:	WA
Zip	:	98391-6134
Country	:	US
Telephone Number	:	253-455-0931
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	03/03/2026

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