Provider Demographics
NPI:1861378085
Name:OMILIAK, MARK ANDREW (PPO COUNSELING)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW
Last Name:OMILIAK
Suffix:
Gender:M
Credentials:PPO COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3553
Mailing Address - Country:US
Mailing Address - Phone:909-895-8913
Mailing Address - Fax:
Practice Address - Street 1:1145 CHURCH ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3553
Practice Address - Country:US
Practice Address - Phone:909-895-8913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230250784101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool