Provider Demographics
NPI:1164722674
Name:OHANLON, SUSAN M (MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:OHANLON
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 1:2238 MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6956
Mailing Address - Country:US
Mailing Address - Phone:530-533-7464
Mailing Address - Fax:530-534-7126
Practice Address - Street 1:2238 MONTE VISTA AVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6956
Practice Address - Country:US
Practice Address - Phone:530-533-7464
Practice Address - Fax:530-534-7126
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist