Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | SW10184 | AZ |
NPI | 1154401214 |
---|---|
Provider Name | Ms. Theresa A. O'brien |
First Address | Cottonwood, AZ 86326-3651 |
Second Address | Cottonwood, AZ 86326-3651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
615164 | (05) | AZ |