Healthcare Provider Details

I. General information

NPI: 1780690149
Provider Name (Legal Business Name): ROBERT PERRY OBRIEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 MONTOPOLIS DR MENTAL HEALTH CLINIC
AUSTIN TX
78741-6411
US

IV. Provider business mailing address

1311 CASEY ST
AUSTIN TX
78745-1014
US

V. Phone/Fax

Practice location:
  • Phone: 512-389-6503
  • Fax: 512-389-6544
Mailing address:
  • Phone: 512-263-2036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number21991
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: