Healthcare Provider Details

I. General information

NPI: 1790333730
Provider Name (Legal Business Name): CALEIA O'BRIEN MS,LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALEIA FLANNIGAN

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 S ILLINOIS AVE
CARBONDALE IL
62903-5912
US

IV. Provider business mailing address

902 W MAIN ST
WEST FRANKFORT IL
62896-2210
US

V. Phone/Fax

Practice location:
  • Phone: 618-457-6703
  • Fax: 618-549-3734
Mailing address:
  • Phone: 618-937-6483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.014846
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: