Provider Demographics
NPI:1629306386
Name:O'BRIEN, SARA N (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:N
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 714
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49429-0714
Mailing Address - Country:US
Mailing Address - Phone:785-477-6793
Mailing Address - Fax:
Practice Address - Street 1:6563 HAMPTON PL APT 2
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442
Practice Address - Country:US
Practice Address - Phone:785-307-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-07-3402103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-07-3402OtherBACB