Provider Demographics
NPI:1114890696
Name:O'CONNOR, TERENCE MICHAEL JR (RADT-1)
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:MICHAEL
Last Name:O'CONNOR
Suffix:JR
Gender:M
Credentials:RADT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4576 E SHIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-7220
Mailing Address - Country:US
Mailing Address - Phone:559-240-9206
Mailing Address - Fax:559-258-0248
Practice Address - Street 1:4576 E SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-7220
Practice Address - Country:US
Practice Address - Phone:559-240-9206
Practice Address - Fax:559-258-0248
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1603690325101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)