Healthcare Provider Details

I. General information

NPI: 1619300936
Provider Name (Legal Business Name): CHRISTINE OBRIEN L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2013
Last Update Date: 08/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N MICHIGAN AVE 711
CHICAGO IL
60601-3901
US

IV. Provider business mailing address

9024 W 140TH ST
ORLAND PARK IL
60462-2159
US

V. Phone/Fax

Practice location:
  • Phone: 708-941-6086
  • Fax:
Mailing address:
  • Phone: 708-941-6086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.009261
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: