Provider Demographics
NPI:1952636193
Name:O'LEARY, MICHAEL S (IMFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:O'LEARY
Suffix:
Gender:M
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 N 6TH ST
Mailing Address - Street 2:APT. 203
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3690
Mailing Address - Country:US
Mailing Address - Phone:614-935-7748
Mailing Address - Fax:614-252-8468
Practice Address - Street 1:5131 POST RD
Practice Address - Street 2:STE. 375
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1160
Practice Address - Country:US
Practice Address - Phone:614-935-7748
Practice Address - Fax:614-252-8468
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF 1000002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist