| Doctor Name: | MR. MICHAEL JOHN OMALLEY |
| NPI Number: | 1013966589 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S., LPC, LMHC |
| License Number: | LH00005368 |
| Business Practice Address: | 8495 Crater Lake Hwy White City, OR - 975033011 |
| Business Phone Number: | 5418262111 |
| Business Fax Number: | 5418303509 |
| Mailing Address: | 352 Shadow Lawn Dr, EAGLE POINT |
| State: | OR |
| Postal Code: | 975246610 |
| Phone Number: | 5418304340 |
| Fax Number: | 5418303509 |
| NPI Enumeration Date: | 05/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LH00005368 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |