Provider Demographics
NPI:1023328796
Name:O'BRIEN, NICOLE HELENE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:HELENE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:HELENE
Other - Last Name:HEUMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:6914 SEBASTOPOL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3459
Mailing Address - Country:US
Mailing Address - Phone:707-529-2910
Mailing Address - Fax:
Practice Address - Street 1:6914 SEBASTOPOL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3459
Practice Address - Country:US
Practice Address - Phone:707-529-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist