Healthcare Provider Details

I. General information

NPI: 1639236169
Provider Name (Legal Business Name): KATHERINE OBRIEN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 BROADWAY
BLUE ISLAND IL
60406-3097
US

IV. Provider business mailing address

5731 W 129TH ST
CRESTWOOD IL
60445-1142
US

V. Phone/Fax

Practice location:
  • Phone: 708-389-6578
  • Fax:
Mailing address:
  • Phone: 708-388-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1305
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: