Provider Demographics
NPI:1710875927
Name:O'BRIEN, MICHAEL C
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15490 BOSTON PKWY APT 111
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-4708
Mailing Address - Country:US
Mailing Address - Phone:815-582-9979
Mailing Address - Fax:
Practice Address - Street 1:4949 WESTOWN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6704
Practice Address - Country:US
Practice Address - Phone:515-344-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1101766104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker