Provider Demographics
NPI:1578139762
Name:JOHN O'BRIEN PSYD, LLC
Entity Type:Organization
Organization Name:JOHN O'BRIEN PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGY CANDIDATE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:720-204-8540
Mailing Address - Street 1:2770 ARAPAHOE RD STE 132-1089
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8018
Mailing Address - Country:US
Mailing Address - Phone:720-204-8540
Mailing Address - Fax:
Practice Address - Street 1:2770 ARAPAHOE RD STE 132-1089
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8018
Practice Address - Country:US
Practice Address - Phone:720-204-8540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073921649Medicaid