Provider Demographics
NPI:1245570068
Name:MARY KATHLEEN O'HARA
Entity Type:Organization
Organization Name:MARY KATHLEEN O'HARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:O'HARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-571-8784
Mailing Address - Street 1:2625 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 103W
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1234
Mailing Address - Country:US
Mailing Address - Phone:630-571-8784
Mailing Address - Fax:
Practice Address - Street 1:2625 BUTTERFIELD RD
Practice Address - Street 2:SUITE 103W
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1234
Practice Address - Country:US
Practice Address - Phone:630-571-8784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
180004804101YP2500X
IL166000225106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty