Provider Demographics
NPI:1952493959
Name:O'TOOLE, COLEEN (MFT)
Entity Type:Individual
Prefix:MS
First Name:COLEEN
Middle Name:
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5762 BOLSA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1172
Mailing Address - Country:US
Mailing Address - Phone:714-898-0362
Mailing Address - Fax:714-893-3267
Practice Address - Street 1:5762 BOLSA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1172
Practice Address - Country:US
Practice Address - Phone:714-898-0362
Practice Address - Fax:714-893-3267
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19068106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist