Provider Demographics
NPI:1548395114
Name:O'BRIEN, MICHAEL JAMES (MEQ)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MEQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1631
Mailing Address - Country:US
Mailing Address - Phone:651-642-1709
Mailing Address - Fax:651-642-0150
Practice Address - Street 1:2375 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 160
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1631
Practice Address - Country:US
Practice Address - Phone:651-642-1709
Practice Address - Fax:651-642-0150
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1988103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist