Provider Demographics
NPI:1023040250
Name:OBRIEN, TERESA (LSCSW, LCSW-R)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:LSCSW, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 N EMPORIA AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2831
Mailing Address - Country:US
Mailing Address - Phone:316-282-4985
Mailing Address - Fax:
Practice Address - Street 1:1234 N EMPORIA AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2831
Practice Address - Country:US
Practice Address - Phone:316-282-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0761201041C0700X
KS47501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical