Provider Demographics
NPI:1336887223
Name:O'BRIEN, ANDREW (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 W 14TH ST # 132
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4051
Mailing Address - Country:US
Mailing Address - Phone:231-538-2046
Mailing Address - Fax:
Practice Address - Street 1:526 W 14TH ST # 132
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4051
Practice Address - Country:US
Practice Address - Phone:231-538-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-22
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011144071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical