Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301014371 | MI |
N | 103G00000X | Clinical Psychologist | 6301014371 | MI |
N | 103TC0700X | Clinical Psychologist | 6301014371 | MI |
Y | 103G00000X | Clinical Psychologist | 6361004588 | MI |
Y | 103TC0700X | Clinical Psychologist | 6361004588 | MI |
NPI | 1295045318 |
---|---|
Provider Name | Tammy Marie O'brien |
First Address | Clarkston, MI 48346-4824 |
Second Address | Farmington Hills, MI 48334-1729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2010 |
Last Update Date | 30/04/2020 |