Provider Demographics
NPI:1497037154
Name:O'DONNELL, DANIEL (LMFT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HAMILTON LNDG STE 230
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-2848
Mailing Address - Country:US
Mailing Address - Phone:707-293-3454
Mailing Address - Fax:415-883-8385
Practice Address - Street 1:3 HAMILTON LNDG STE 230
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-2848
Practice Address - Country:US
Practice Address - Phone:707-293-3454
Practice Address - Fax:415-883-8385
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85630106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist