Provider Demographics
NPI:1407193170
Name:O'BRYAN, TERRI KATHLEEN (ACSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:KATHLEEN
Last Name:O'BRYAN
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:KATHLEEN
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:795 JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-3628
Mailing Address - Country:US
Mailing Address - Phone:530-252-4667
Mailing Address - Fax:530-257-1101
Practice Address - Street 1:795 JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-3628
Practice Address - Country:US
Practice Address - Phone:530-252-4667
Practice Address - Fax:530-257-1101
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 334511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical