Healthcare Provider Details

I. General information

NPI: 1942485503
Provider Name (Legal Business Name): KATHLEEN A O'BRIEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7270 FORESTVIEW LN N STE 150
MAPLE GROVE MN
55369-5568
US

IV. Provider business mailing address

7270 FORESTVIEW LN N STE 150
MAPLE GROVE MN
55369-5568
US

V. Phone/Fax

Practice location:
  • Phone: 763-416-4167
  • Fax: 763-416-4137
Mailing address:
  • Phone: 763-416-4167
  • Fax: 763-416-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1439
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: