Provider Demographics
NPI:1578121489
Name:OBRIEN-CASEY, LAURIE ANNE
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:OBRIEN-CASEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANNE
Other - Last Name:OBRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:433 KITTY HAWK RD STE 211
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3829
Mailing Address - Country:US
Mailing Address - Phone:210-727-5515
Mailing Address - Fax:210-598-1910
Practice Address - Street 1:433 KITTY HAWK RD STE 211
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3829
Practice Address - Country:US
Practice Address - Phone:210-727-5515
Practice Address - Fax:210-598-1910
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66285101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional