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General NPI Number Information
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NPI Number | 1790414191
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Entity Type | Individual
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Provider Name | JOHN J O'DONNELL III LMFT #131080
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Gender | Male
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 22431 ANTONIO PKWY STE B160 ROOM #262
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-3932
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Country | US
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Telephone | 816-215-9817
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Fax |
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Provider Business Mailing Address
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Address Line | 22431 ANTONIO PKWY STE B160
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-3932
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Country | US
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Telephone | 816-215-9817
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 131080
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License Number State | CA
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