Provider Demographics
NPI:1184067191
Name:O'BRIEN, HEATHER (PSYD, HSPP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 WINDSOR RD
Mailing Address - Street 2:SUITE 2617
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-6217
Mailing Address - Country:US
Mailing Address - Phone:217-693-6072
Mailing Address - Fax:309-588-4115
Practice Address - Street 1:808 S ELDORADO RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-6071
Practice Address - Country:US
Practice Address - Phone:309-706-3190
Practice Address - Fax:309-588-4115
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042680A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist