Provider Demographics
NPI:1790414191
Name:O'DONNELL, JOHN J III (LMFT #131080)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:O'DONNELL
Suffix:III
Gender:M
Credentials:LMFT #131080
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22431 ANTONIO PKWY STE B160
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3932
Mailing Address - Country:US
Mailing Address - Phone:816-215-9817
Mailing Address - Fax:
Practice Address - Street 1:22431 ANTONIO PKWY STE B160
Practice Address - Street 2:ROOM #262
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3932
Practice Address - Country:US
Practice Address - Phone:816-215-9817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131080106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty