Provider Demographics
NPI:1689101545
Name:O'CONNER, AMBER HOPE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:HOPE
Last Name:O'CONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-3847
Mailing Address - Country:US
Mailing Address - Phone:256-322-1061
Mailing Address - Fax:
Practice Address - Street 1:1842 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-3847
Practice Address - Country:US
Practice Address - Phone:256-322-1061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician