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General NPI Number Information
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NPI Number | 1699566133
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Entity Type | Individual
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Provider Name | EVAN JOHN OHARA LLC
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Gender | Male
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 1460 WALTON BLVD
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-1768
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Country | US
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Telephone | 248-608-4514
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Fax |
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Provider Business Mailing Address
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Address Line | 475 W BRECKENRIDGE ST
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City | FERNDALE
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State | MI
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Zip | 48220-1745
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Country | US
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Telephone | 248-496-0334
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451024357
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License Number State | MI
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