Provider Demographics
NPI:1710497664
Name:O'CONNELL-LUSSIER, MARY ELLEN (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:O'CONNELL-LUSSIER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:LUSSIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10433 WILSHIRE BLVD APT 409
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10433 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4637
Practice Address - Country:US
Practice Address - Phone:310-712-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty