Provider Demographics
NPI:1174135180
Name:O'BRIEN, KELLY THERESE
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:THERESE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5167 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-6021
Mailing Address - Country:US
Mailing Address - Phone:512-458-0260
Mailing Address - Fax:
Practice Address - Street 1:5167 W 111TH ST
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-6021
Practice Address - Country:US
Practice Address - Phone:773-524-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst