Provider Demographics
NPI:1639820905
Name:O'BRYAN, CHRISTOPHER NATHAN (MSW, RCSWI)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:NATHAN
Last Name:O'BRYAN
Suffix:
Gender:M
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32128 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4622
Mailing Address - Country:US
Mailing Address - Phone:270-392-5194
Mailing Address - Fax:
Practice Address - Street 1:32128 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4622
Practice Address - Country:US
Practice Address - Phone:270-392-5194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health