1174663504

Everything you always wanted to know about MISS O'MALLEY ELLEN LMHC but were afraid to ask.

MISS O'MALLEY ELLEN LMHC

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Provider Prefix Provider Last Name Provider First Name Provider Credential
MISS O'MALLEY ELLEN LMHC
Gender:
Female
Enumeration date:
2007-02-07
Last update date:
2013-04-15
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No
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Identifiers

identifier description issuer state
760418100 Medicaid none FL

Taxonomies

Taxonomy State License Number Primary?
101YM0800X Mental Health FL MH 6031 Y

Phone Numbers

Type Number
Mailing Address Telephone Number 2398226718
Practice Location Address Telephone Number 2398226718

Addresses

Type Address City State Postal Country
Mailing Address 12350 WOODROSE CT APT 3 FORT MYERS FL 33907 FL
Practice Location Address 12350 WOODROSE CT APT 3 FORT MYERS FL 33907 FL