Provider Demographics
NPI:1275868457
Name:O'BRIEN, WILLIAM THOMAS
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THOMAS
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 COUNTY ROAD D E # B
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5353
Mailing Address - Country:US
Mailing Address - Phone:651-748-5019
Mailing Address - Fax:651-773-7591
Practice Address - Street 1:2115 COUNTY ROAD D E # B
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5353
Practice Address - Country:US
Practice Address - Phone:651-748-5019
Practice Address - Fax:651-773-7591
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health