Healthcare Provider Details

I. General information

NPI: 1184967283
Provider Name (Legal Business Name): KEVIN JAMES OHARA LBSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7444 S WHISPERING HILLS DR
TRAVERSE CITY MI
49684-9465
US

IV. Provider business mailing address

7444 S WHISPERING HILLS DR
TRAVERSE CITY MI
49684-9465
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-3765
  • Fax:
Mailing address:
  • Phone: 231-935-3765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802057879
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: