Provider Demographics
NPI:1376839928
Name:O'BRIEN, KRISTAL LYNN (MHS-RC, CRC)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:LYNN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MHS-RC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DONALD CT
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-3841
Mailing Address - Country:US
Mailing Address - Phone:504-813-0176
Mailing Address - Fax:
Practice Address - Street 1:521 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-4716
Practice Address - Country:US
Practice Address - Phone:504-324-6265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00112937225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor