Provider Demographics
NPI:1396098778
Name:O'HARA, COLLEEN (MS LMFT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:O'HARA
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70643
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91117-7643
Mailing Address - Country:US
Mailing Address - Phone:626-765-7103
Mailing Address - Fax:
Practice Address - Street 1:444 E HUNTINGTON DR STE 333
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-6204
Practice Address - Country:US
Practice Address - Phone:626-765-7103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51505106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist