Healthcare Provider Details

I. General information

NPI: 1174792303
Provider Name (Legal Business Name): DEBRA ANN O'BERRY MA, LPC, CAAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3827 W HOWELL RD
MASON MI
48854-9537
US

IV. Provider business mailing address

3827 W HOWELL RD
MASON MI
48854-9537
US

V. Phone/Fax

Practice location:
  • Phone: 517-256-6751
  • Fax: 517-676-4941
Mailing address:
  • Phone: 517-256-6751
  • Fax: 517-676-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC00579
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberL1226537
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401009368
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: