Provider Demographics
NPI:1053485862
Name:O'NEILL, KATHLEEN DONNELLY (MFT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:DONNELLY
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N B ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-6901
Mailing Address - Country:US
Mailing Address - Phone:805-737-6690
Mailing Address - Fax:
Practice Address - Street 1:117 N B ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6901
Practice Address - Country:US
Practice Address - Phone:805-737-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT41402101YM0800X
LMFT41402106H00000X
CAMFT41402106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health