Provider Demographics
NPI:1417220575
Name:O'MEARA, MARLEIGH CORINNE (LPC)
Entity Type:Individual
Prefix:
First Name:MARLEIGH
Middle Name:CORINNE
Last Name:O'MEARA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-2605
Mailing Address - Country:US
Mailing Address - Phone:602-258-6797
Mailing Address - Fax:602-254-7121
Practice Address - Street 1:1209 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-2605
Practice Address - Country:US
Practice Address - Phone:602-258-6797
Practice Address - Fax:602-254-7121
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC13325101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional