Provider Demographics
NPI:1902940133
Name:MICHAEL F OCONNELL PHD
Entity Type:Organization
Organization Name:MICHAEL F OCONNELL PHD
Other - Org Name:ROGUE VALLEY PSYCHOLOGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:541-773-4077
Mailing Address - Street 1:728 CARDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6124
Mailing Address - Country:US
Mailing Address - Phone:541-773-4077
Mailing Address - Fax:541-773-3621
Practice Address - Street 1:728 CARDLEY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6124
Practice Address - Country:US
Practice Address - Phone:541-773-4077
Practice Address - Fax:541-773-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR452103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCBBDMedicare PIN