Provider Demographics
NPI:1952638645
Name:O'BRIEN, JANICE FAE (BHRS/CM)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:FAE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:BHRS/CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 S 11TH ST
Mailing Address - Street 2:P.O. BOX 532
Mailing Address - City:FREDERICK
Mailing Address - State:OK
Mailing Address - Zip Code:73542-7011
Mailing Address - Country:US
Mailing Address - Phone:580-335-2052
Mailing Address - Fax:580-335-7730
Practice Address - Street 1:1500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:OK
Practice Address - Zip Code:73542-1421
Practice Address - Country:US
Practice Address - Phone:580-335-3320
Practice Address - Fax:580-335-7443
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health