Provider Demographics
NPI:1760999031
Name:O'DONNELL, MICHAEL JOSEPH JR (CADTP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:O'DONNELL
Suffix:JR
Gender:M
Credentials:CADTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:525 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2606
Mailing Address - Country:US
Mailing Address - Phone:805-501-9675
Mailing Address - Fax:
Practice Address - Street 1:525 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2606
Practice Address - Country:US
Practice Address - Phone:805-501-9675
Practice Address - Fax:818-985-7193
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7054101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)