Healthcare Provider Details

I. General information

NPI: 1952636193
Provider Name (Legal Business Name): MICHAEL S. O'LEARY IMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 POST RD STE. 375
DUBLIN OH
43017-1160
US

IV. Provider business mailing address

895 N 6TH ST APT. 203
COLUMBUS OH
43201-3690
US

V. Phone/Fax

Practice location:
  • Phone: 614-935-7748
  • Fax: 614-252-8468
Mailing address:
  • Phone: 614-935-7748
  • Fax: 614-252-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF 1000002
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: