Provider Demographics
NPI:1134809569
Name:OBRIEN, MILES (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5004 THOMPSON TER STE 112
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6130
Mailing Address - Country:US
Mailing Address - Phone:817-918-4588
Mailing Address - Fax:817-547-0749
Practice Address - Street 1:5004 THOMPSON TER STE 112
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6130
Practice Address - Country:US
Practice Address - Phone:817-918-4588
Practice Address - Fax:817-547-0749
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional