Healthcare Provider Details

I. General information

NPI: 1427189430
Provider Name (Legal Business Name): ELLEN R OBRIEN M.A., MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44285 LOWTREE AVE
LANCASTER CA
93534-4170
US

IV. Provider business mailing address

43765 BRANDON THOMAS WAY
LANCASTER CA
93536-1777
US

V. Phone/Fax

Practice location:
  • Phone: 661-341-3900
  • Fax: 661-341-3904
Mailing address:
  • Phone: 661-733-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC46615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: