Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6301011314 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6401003437 | MI |
NPI | 1154351773 |
---|---|
Provider Name | Dr. Brenda Sue O'brien |
First Address | Ferndale, MI 48220-1395 |
Second Address | Taylor, MI 48180-5343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |