Healthcare Provider Details

I. General information

NPI: 1073035069
Provider Name (Legal Business Name): CARLEIGH OBRIEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 FORT MISSOULA RD STE A
MISSOULA MT
59804-7218
US

IV. Provider business mailing address

30 FORT MISSOULA RD STE A
MISSOULA MT
59804-7218
US

V. Phone/Fax

Practice location:
  • Phone: 773-870-5396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-22989
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: