Provider Demographics
NPI:1427189430
Name:OBRIEN, ELLEN R (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:R
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43765 BRANDON THOMAS WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1777
Mailing Address - Country:US
Mailing Address - Phone:661-733-0445
Mailing Address - Fax:
Practice Address - Street 1:44285 LOWTREE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4170
Practice Address - Country:US
Practice Address - Phone:661-341-3900
Practice Address - Fax:661-341-3904
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46615106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46615OtherBBS