Healthcare Provider Details

I. General information

NPI: 1215533013
Provider Name (Legal Business Name): CRISTIN O'BRIEN LMHC, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14499 N DALE MABRY HWY STE 130S
TAMPA FL
33618-2071
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 877-653-5907
  • Fax:
Mailing address:
  • Phone: 877-653-5907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19858
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number10246
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003805A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: