Provider Demographics
NPI:1740557206
Name:O'BRIEN, MICHAEL ERIC (PSYD HSPP)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERIC
Last Name:O'BRIEN
Suffix:
Gender:M
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 1:13200 DUNWOODY LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8742
Mailing Address - Country:US
Mailing Address - Phone:317-258-5058
Mailing Address - Fax:317-575-6453
Practice Address - Street 1:5336 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-6023
Practice Address - Country:US
Practice Address - Phone:317-258-5058
Practice Address - Fax:317-575-6453
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041591A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical