Healthcare Provider Details

I. General information

NPI: 1861301160
Provider Name (Legal Business Name): CHARLES BO O'BRIEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 GRAND AVE
FRANKLIN PARK IL
60131-2563
US

IV. Provider business mailing address

1032 W GLENCOE RD
PALATINE IL
60067-5957
US

V. Phone/Fax

Practice location:
  • Phone: 847-451-0330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: