Provider Demographics
NPI:1962289017
Name:OMLOR, BETTY (LMFT)
Entity type:Individual
Prefix:MISS
First Name:BETTY
Middle Name:
Last Name:OMLOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 481
Mailing Address - Street 2:
Mailing Address - City:WRIGHTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:92397-0481
Mailing Address - Country:US
Mailing Address - Phone:909-319-1144
Mailing Address - Fax:
Practice Address - Street 1:1420 BETTY STREET
Practice Address - Street 2:
Practice Address - City:WRIGHTWOOD
Practice Address - State:CA
Practice Address - Zip Code:92397-0481
Practice Address - Country:US
Practice Address - Phone:909-319-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT132862106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist