Provider Demographics
NPI:1770664252
Name:O'BRIEN, MARIAN 'MICKI' D (MED,, LPC)
Entity Type:Individual
Prefix:MS
First Name:MARIAN 'MICKI'
Middle Name:D
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MED,, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1957
Mailing Address - Country:US
Mailing Address - Phone:512-494-9294
Mailing Address - Fax:512-478-7442
Practice Address - Street 1:2813 GLENVIEW AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1957
Practice Address - Country:US
Practice Address - Phone:512-494-9294
Practice Address - Fax:512-478-7442
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1802LCOtherBCBS PROVIDER #