MEDICARE: RUTH S. O'BRIEN, PSYD PLLC

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
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1508480856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUTH S. O'BRIEN, PSYD PLLC

Provider Business Mailing Address
First Line	:	6245 SILVERADO TRL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-2915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 TEMPLETON GAP RD STE 107
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8728
Country	:	US
Telephone Number	:	719-257-3926
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RUTH O'BRIEN
Credential	:	PSYD
Telephone Number	:	719-257-3926

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	02/28/2022

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