Provider Demographics
NPI:1972523462
Name:O'CONNOR, TERRENCE (MA, MFT)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:1090 SUNNYCREST AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1209
Mailing Address - Country:US
Mailing Address - Phone:310-396-4942
Mailing Address - Fax:805-642-3424
Practice Address - Street 1:1090 SUNNYCREST AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1209
Practice Address - Country:US
Practice Address - Phone:310-396-4942
Practice Address - Fax:805-642-3424
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37696106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist