Healthcare Provider Details

I. General information

NPI: 1558860155
Provider Name (Legal Business Name): CHRISTINA MARIE O'BRIEN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA MARIE KOEPPEL LPCC

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 N MARENGO AVE STE 100
PASADENA CA
91101-4550
US

IV. Provider business mailing address

95 N MARENGO AVE STE 100
PASADENA CA
91101-4550
US

V. Phone/Fax

Practice location:
  • Phone: 626-585-8075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC18978
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC6029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: