Healthcare Provider Details

I. General information

NPI: 1134741341
Provider Name (Legal Business Name): JANE ELIZABETH OBRIEN LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 11/27/2023
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 HARROUN AVE STE F
MCKINNEY TX
75069-3433
US

IV. Provider business mailing address

PO BOX 241
MCKINNEY TX
75070-8135
US

V. Phone/Fax

Practice location:
  • Phone: 972-548-0209
  • Fax:
Mailing address:
  • Phone: 972-548-0209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4060
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: