Provider Demographics
NPI:1215533013
Name:O'BRIEN, CRISTIN (LMHC, MT-BC)
Entity type:Individual
Prefix:
First Name:CRISTIN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LMHC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 OLD BAINBRIDGE RD APT 401
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-2678
Mailing Address - Country:US
Mailing Address - Phone:260-205-2636
Mailing Address - Fax:
Practice Address - Street 1:2940 E PARK AVE STE 1A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3446
Practice Address - Country:US
Practice Address - Phone:850-778-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003805A101YM0800X
10246225A00000X
FLMH19858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist