Healthcare Provider Details

I. General information

NPI: 1124838073
Provider Name (Legal Business Name): HAILEY O'BRIEN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E PARK AVE
ANACONDA MT
59711-2340
US

IV. Provider business mailing address

205 E PARK AVE
ANACONDA MT
59711-2340
US

V. Phone/Fax

Practice location:
  • Phone: 406-563-8117
  • Fax:
Mailing address:
  • Phone: 406-563-8117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number72775
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: