Provider Demographics
NPI:1538324033
Name:O'BRIEN, KEVEN PATRICK
Entity Type:Individual
Prefix:
First Name:KEVEN
Middle Name:PATRICK
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:OBRIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1910 N BUSH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2816
Mailing Address - Country:US
Mailing Address - Phone:714-361-7950
Mailing Address - Fax:714-361-7966
Practice Address - Street 1:275 BAKER ST E
Practice Address - Street 2:SUITE A
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4566
Practice Address - Country:US
Practice Address - Phone:714-361-6760
Practice Address - Fax:714-361-6768
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health