Provider Demographics
NPI:1356428932
Name:OMDAHL, DORIS LILIAM (LMHC)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:LILIAM
Last Name:OMDAHL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 PARK CENTER DRIVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835
Mailing Address - Country:US
Mailing Address - Phone:407-523-1219
Mailing Address - Fax:407-523-2398
Practice Address - Street 1:2101 PARK CENTER DRIVE
Practice Address - Street 2:SUITE 270
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835
Practice Address - Country:US
Practice Address - Phone:407-523-1219
Practice Address - Fax:407-523-2398
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMHC3042101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor