Healthcare Provider Details

I. General information

NPI: 1457727414
Provider Name (Legal Business Name): AERIN ALEX OMALLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MASON ST
UKIAH CA
95482-4482
US

IV. Provider business mailing address

169 MASON ST
UKIAH CA
95482-4482
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-3300
  • Fax:
Mailing address:
  • Phone: 707-463-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT114059
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF8607
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT114059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: