=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598125445
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN ELIZABETH O'BRIEN MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2016
-----------------------------------------------------
Last Update Date | 12/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 N FRANKLIN AVE STE 687 #5238
-----------------------------------------------------
City | PINEDALE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82941-9049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-871-5468
-----------------------------------------------------
Fax | 307-314-0060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34 N FRANKLIN AVE STE 687 #5238
-----------------------------------------------------
City | PINEDALE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82941-9049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-871-5468
-----------------------------------------------------
Fax | 307-314-0060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 22241
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 36976
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 11999193-3501
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1056
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------