Provider Demographics
NPI:1083276919
Name:O'BRIEN, JILLIAN (MA, PLPC)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:HAMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62046-1062
Mailing Address - Country:US
Mailing Address - Phone:217-556-0273
Mailing Address - Fax:
Practice Address - Street 1:967 GARDENVIEW OFFICE PKWY STE 16
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5917
Practice Address - Country:US
Practice Address - Phone:314-275-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017014821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health