Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1997 | CO |
NPI | 1073680369 |
---|---|
Provider Name | Dr. Beth O'brien |
First Address | Fort Collins, CO 80526-8115 |
Second Address | Fort Collins, CO 80526-8115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |