Provider Demographics
NPI:1851379432
Name:O BRIEN, JASON D (LPC LMFT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:D
Last Name:O BRIEN
Suffix:
Gender:M
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:24064
Mailing Address - Country:US
Mailing Address - Phone:540-977-6300
Mailing Address - Fax:540-977-9523
Practice Address - Street 1:3522 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:24064
Practice Address - Country:US
Practice Address - Phone:540-977-6300
Practice Address - Fax:540-977-9523
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002529101YP2500X
VA0717000613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005415756Medicaid