Provider Demographics
NPI:1457872921
Name:O'BOYLE, MICHELE (MA, QMHP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:O'BOYLE
Suffix:
Gender:F
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995-1328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1307 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1139
Practice Address - Country:US
Practice Address - Phone:618-997-5336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health