Provider Demographics
NPI:1053794206
Name:O'CONNOR, DENETT (LISAC MASTERS MGMT)
Entity type:Individual
Prefix:
First Name:DENETT
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LISAC MASTERS MGMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N. KNOX DR.
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-3334
Mailing Address - Country:US
Mailing Address - Phone:520-514-9888
Mailing Address - Fax:520-514-9878
Practice Address - Street 1:7756 E. BROADWAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710
Practice Address - Country:US
Practice Address - Phone:520-514-9888
Practice Address - Fax:520-514-9878
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-1701101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)