Provider Demographics
NPI:1710219779
Name:KATHLEEN A. O'BRIEN
Entity Type:Organization
Organization Name:KATHLEEN A. O'BRIEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN O'BRIEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:763-420-7308
Mailing Address - Street 1:9181 CHESSHIRE LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-8858
Mailing Address - Country:US
Mailing Address - Phone:763-420-7308
Mailing Address - Fax:763-420-7308
Practice Address - Street 1:9181 CHESSHIRE LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-8858
Practice Address - Country:US
Practice Address - Phone:763-420-7308
Practice Address - Fax:763-420-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1439106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty