Healthcare Provider Details

I. General information

NPI: 1982919601
Provider Name (Legal Business Name): MRS. GAIL O'CONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NANCY O'CONNELL

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16530 VENTURA BLVD
ENCINO CA
91436-4554
US

IV. Provider business mailing address

11600 ELDRIDGE AVE
LAKE VIEW TERRACE CA
91342-6506
US

V. Phone/Fax

Practice location:
  • Phone: 818-584-2677
  • Fax:
Mailing address:
  • Phone: 818-686-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: