Provider Demographics
NPI:1215141288
Name:O'CONNOR, LAURA B (PSY D, MFT, BCBA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:O'CONNOR
Suffix:
Gender:
Credentials:PSY D, MFT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 S MACADAM AVE STE 90
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4285
Mailing Address - Country:US
Mailing Address - Phone:310-883-5431
Mailing Address - Fax:
Practice Address - Street 1:4640 S MACADAM AVE STE 90
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4285
Practice Address - Country:US
Practice Address - Phone:503-292-0765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3371103TC0700X
CA44226106H00000X
225C00000X, 390200000X
CAMFC 44226390200000X
CA29491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program