Provider Demographics
NPI:1598897373
Name:O'BRIEN, SHEENA C (MA LP)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:C
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 GRAND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3492
Mailing Address - Country:US
Mailing Address - Phone:612-454-1656
Mailing Address - Fax:651-560-3768
Practice Address - Street 1:658 GRAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3492
Practice Address - Country:US
Practice Address - Phone:612-454-1656
Practice Address - Fax:651-560-3768
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5125103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist