Provider Demographics
NPI:1023181633
Name:OBRIEN, WILLIAM HAYES (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HAYES
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:OH
Mailing Address - Zip Code:43451-0048
Mailing Address - Country:US
Mailing Address - Phone:419-372-2974
Mailing Address - Fax:419-372-6013
Practice Address - Street 1:OF PSYCHOLOGY
Practice Address - Street 2:BOWLING GREEN STATE UNIVERSITY
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43403-0001
Practice Address - Country:US
Practice Address - Phone:419-372-2973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4553103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OBCP12801Medicare ID - Type Unspecified