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NPI Code Detail

MEDICARE: WILLIAM HAYES OBRIEN PH.D.

MEDICARE: WILLIAM HAYES OBRIEN PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TH0100XHealth Service Psychologist4553OH

General Provider Information

NPI Number : 1023181633
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM HAYES OBRIEN PH.D.
Provider Business Mailing Address
First Line : PO BOX 48
Second Line :
City : PORTAGE
State : OH
Zip : 43451-0048
Country : US
Telephone Number : 419-372-2974
Fax Number : 419-372-6013
Provider Business Practice Location Address
First Line : OF PSYCHOLOGY
Second Line : BOWLING GREEN STATE UNIVERSITY
City : BOWLING GREEN
State : OH
Zip : 43403-0001
Country : US
Telephone Number : 419-372-2973
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2006
Last Update Date : 07/08/2007

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