Healthcare Provider Details

I. General information

NPI: 1598575680
Provider Name (Legal Business Name): HOLLY O'BRIEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 SUNSET RD SW
CLAY CITY IL
62824-1113
US

IV. Provider business mailing address

1920 E HEART GROVE LN
DUNDAS IL
62425-2214
US

V. Phone/Fax

Practice location:
  • Phone: 618-662-2131
  • Fax:
Mailing address:
  • Phone: 618-843-5932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.012860
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: