Provider Demographics
NPI:1487915021
Name:O'DONNELL, LYNETTE (MFT)
Entity type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:
Last Name:O'DONNELL
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 1:1828 SHASTA ACRES RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9444
Mailing Address - Country:US
Mailing Address - Phone:530-209-1257
Mailing Address - Fax:
Practice Address - Street 1:427 ALDER ST
Practice Address - Street 2:BOX 557
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2306
Practice Address - Country:US
Practice Address - Phone:530-209-1257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44893106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist