Provider Demographics
NPI:1235116294
Name:OCONNOR, KACEE J (MED, LCPC, LMFT)
Entity type:Individual
Prefix:MS
First Name:KACEE
Middle Name:J
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:MED, LCPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 GOODING ST N
Mailing Address - Street 2:SUITE D
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6179
Mailing Address - Country:US
Mailing Address - Phone:208-732-0405
Mailing Address - Fax:208-732-0407
Practice Address - Street 1:233 GOODING ST N
Practice Address - Street 2:SUITE D
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6179
Practice Address - Country:US
Practice Address - Phone:208-732-0405
Practice Address - Fax:208-732-0407
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC2968101Y00000X
IDLMFT2967101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor