Provider Demographics
NPI:1427355882
Name:O'BRIEN, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 BROOKLAWN CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1282
Mailing Address - Country:US
Mailing Address - Phone:502-451-5177
Mailing Address - Fax:502-451-0896
Practice Address - Street 1:3121 BROOKLAWN CAMPUS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1282
Practice Address - Country:US
Practice Address - Phone:502-451-5177
Practice Address - Fax:502-451-0896
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1614101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100254670Medicaid
KY7100254690Medicaid
KY7100254680Medicaid
KY1740554864Medicaid
KY7100254660Medicaid