Healthcare Provider Details

I. General information

NPI: 1538209218
Provider Name (Legal Business Name): MERRILEE O'BRIEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SKYPARK DR 220
TORRANCE CA
90505-5023
US

IV. Provider business mailing address

PO BOX 1596
VISTA CA
92085-1596
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-5776
  • Fax: 310-257-5753
Mailing address:
  • Phone: 310-257-5776
  • Fax: 310-257-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC30075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: